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Health Contract With Sedentary Older Adults
Abstract
Health educators used health contracts with sedentary older adults for the purpose of increasing exercise or physical activity.
Two health educators helped 25 sedentary older adults complete health contracts, and then they conducted follow-up evaluations. The percentage of scheduled exercise sessions successfully completed by older adults was calculated. Participants were asked if each of five components of the health contract-motivation, goal setting, social support, memory techniques, and problem solving-was helpful in achieving their exercise goals.
Of the 25 participants, 20 achieved at least 75% of their exercise goals and 15 had a 100% success rate. Most of the older adults reported that several behavioral, social, and cognitive strategies were helpful to them.
This technique may be applied by health educators or clinicians in a variety of settings and can be focused on one of several potential risk factors.
... Such contracts have been used in health consultations to empower the patient in decision making; to discuss potential problems and solutions; to provide clear monitoring, responsibility, and accountability; and plan incentives to reinforce the behaviour (Janz, Becker, & Hartman, 1984). This combination of graduated goals, empowerment, and self-monitoring are based on social cognitive theory (Haber & Rhodes, 2004). ...
... A pilot study found that older people who completed a behavioural contract to do more physical activity increased their level of exercise, with 20/25 participants achieving at least 75% increase in exercise sessions (Haber & Rhodes, 2004). Other studies with behavioural contracts to do more physical activity have found positive results for writing a specific plan. ...
... If their plan was completed realistically, the participant had developed a plan that they were confident they were able to perform. Thus, the action plan conception of the recommended activities, in comparison to a relatively vague conception (before completing an action plan), was expected to attract higher reports of self-efficacy (Bandura, 1997;Haber & Rhodes, 2004;Janz et aI., 1984;Kanfer & Gaelick, 1986;Locke & Latham, 1990). Although self-efficacy was greater for implementing an action plan, intention was not. ...
p>This thesis evaluated the use of tailoring in falls prevention. A website was created that presented tailored advice intended to encourage older adults to undertake balance training. Theory and research guided the selection of factors chosen to tailor the advice and to evaluate its efficacy. From interviews with older people and health and social care providers, views towards the website suggested that the website was usable and acceptable. In a randomised controlled evaluation comparing the tailored advice with a generic equivalent, questionnaire scores indicated that after receiving the tailored advice, older people reported that the advice was more personally relevant, and reported greater confidence and intention to undertake balance training. Completing an action plan also increased older people’s confidence to undertake balance training.
Based on feedback from participants derived from the two qualitative studies and the limitations identified from the quantitative study, a revised version of the website was created and re-tested. In a partial replication study, the tailored advice was reported by older people as more personally relevant and good for them to do, and creating an action plan increased their confidence to undertake balance training, although the effects of the intervention on intentions were weaker than in the first study, and did not quite reach significance. Nevertheless, the effect of tailoring on personal relevance and intention, and the effect of an action plan on confidence were significant in a meta-analysis of the two quantitative studies. Whilst not conclusive, this research suggests that a website providing tailored advice to encourage older people to undertake balance training may be usable and acceptable, and lead to greater intention and confidence to undertake balance training.</p
... A behavior contract is comprised of a written agreement between two parties that signifies the behavior intended for change, how the individual will accomplish the change, and the consequence that will follow if he or she does meet the agreement outlined in the contract (Haber & Rhodes, 2004). In a study done by Wysocki et al. (1979), participants who wanted to increase their exercise met weekly in order to sign contracts and to deposit items of personal importance for the upcoming week. ...
... Stimulus control procedures consist of antecedent and setting event manipulations along with stimulus prompts. Stimulus control procedures have been used to endorse exercise in inactive adults (Haber & Rhodes, 2004), to encourage children diagnosed with autism to engage in leisure activities (Kaplan-Reimer, Sidener, Reeve, & Sidener, 2010), and to improve performance in track and field for an athlete (D. Scott, Scott, & Goldwater, 1997). ...
... Results from this study showed that once the intervention was initiated levels of exercise for all three participants increased and maintained over a two-year period. Haber and Rhodes (2004) also employed stimulus control procedures such as leaving prompts in highly visible locations, using a calendar to record exercise goals, and having an individual remind participants to exercise each day. ...
Goal-setting procedures have been employed in many different sports, and have been shown to be a beneficial component for enhancing sports performance. For this study, a changing-criterion within multiple-baseline design was used to evaluate a multi-component intervention for increasing running distance for five healthy adults. The intervention consisted of goal setting with performance feedback. Participants set a short-term goal each week and a long-term goal to achieve upon completion of the study. The study incorporated the use of the NikeTM + SportKit for automated recording of the distance of each run. Results of the current study demonstrated for all participants that goal setting and performance feedback was an effective method to enhance sports performance for individuals wanting to increase their running distance.
... eating disorders) and patient populations (e.g. adult dialysis patients) (20)(21)(22)(23)(24)(25)(26)(27). However, no published articles were found concerning behavioral contracting effects on IST adherence in a renal transplant population. ...
... IST adherence contracts generally followed the format described by Haber and Rhodes (22): goal setting, motivation, social support, memory techniques and problem-solving. We added a sixth component, consequences of nonadherence, as such knowledge has been identified as part of effective behavioral contracts (18,32,33). ...
... Findings of prior research indicate behavioral contracts have improved treatment adherence and related outcomes in other patient populations, e.g. hemodialysis patients (20)(21)(22)(23)(24)(25)(26)(27). Similar patterns of increased adherence were noted in the current study. ...
The objective of this randomized controlled trial was to assess the effects of a 1-year behavioral contract intervention on immunosuppressant therapy (IST) adherence and healthcare utilizations and costs among adult renal transplant recipients (RTRs). The sample included adult RTRs who were at least 1 year posttransplant, taking tacrolimus or cyclosporine and served by a specialty pharmacy. Pharmacy refill records were used to measure adherence and monthly questionnaires were used to measure healthcare utilizations. Direct medical costs were estimated using the 2009 Medicare Expenditure Panel Survey. Adherence was analyzed using the GLM procedure and the MIXED procedure of SAS. Rate ratios and 95% confidence intervals were estimated to quantify the rate of utilizing healthcare services relative to treatment assignment. One hundred fifty RTRs were enrolled in the study. Intervention group RTRs (n = 76) had higher adherence than control group RTRs (n = 74) over the study period (p < 0.01). And 76.1% of the intervention group compared with 42.7% of the control group was not hospitalized during the 1-year study period (RR = 1.785; 95% CI: 1.314, 2.425), resulting in cost savings. Thus, evidence supports using behavioral contracts as an effective adherence intervention that may improve healthcare outcomes and lower costs.
... These strategies include: education about the benefits of physical activity, advice about suitable activities, identifying and overcoming any perceived barriers to engage in physical activity, setting goals, and recruiting social support [14,23,24]. Part of the educational workbook is a health contract: a written agreement signed by the patient and physiotherapist to support them in initiating and maintaining physical activities [25]. A logbook monitors the specific goals. ...
... 3) Goal setting Patient and coach create activity goals in order to obtain the 6-month-goals (as formulated in the health contract). Goals have to be realistic, concrete and individualized and have to be formulated in a systematic way, based on behavioral change theories [25]. ...
... All participating physical therapists were specifically trained to treat patients in both treatment arms and informed about the aim of the study. Special attention was given to models of behavioral change, [14,17] to specific strategies of coaching sedentary patients, [15,33] and to the technique of setting realistic, concrete and individualized goals [25]. Throughout the trial, therapists continuously register the individual treatment sessions. ...
Many patients with Parkinson's disease (PD) lead a sedentary lifestyle. Promotion of physical activities may beneficially affect the clinical presentation of PD, and perhaps even modify the course of PD. However, because of physical and cognitive impairments, patients with PD require specific support to increase their level of physical activity.
We developed the ParkFit Program: a PD-specific and multifaceted behavioral program to promote physical activity. The emphasis is on creating a behavioral change, using a combination of accepted behavioral motivation techniques. In addition, we designed a multicentre randomized clinical trial to investigate whether this ParkFit Program increases physical activity levels over two years in sedentary PD patients. We intended to include 700 sedentary patients. Primary endpoint is the time spent on physical activities per week, which will be measured every six months using an interview-based 7-day recall.
In total 3453 PD patients were invited to participate. Ultimately, 586 patients--with a mean (SD) age of 64.1 (7.6) years and disease duration of 5.3 (4.5) years--entered the study. Study participants were younger, had a shorter disease duration and were less sedentary compared with eligible PD patients not willing to participate.
The ParkFit trial is expected to yield important new evidence about behavioral interventions to promote physical activity in sedentary patients with PD. The results of the trial are expected in 2012.
http://clinicaltrials.gov (nr NCT00748488).
... ,17,31,36,[48][49][50]53,55,58,71,73,79,81 Only 14 articles (20%) mentioned health behaviour theories specific to their respective contracts (Box 2).12,17,31,36,[48][49][50]53,55,58,71,73,79,81 Contract implementation Only 11 articles (14%) mentioned or described training of health care professionals for the implementation ofBox 1. ...
... ,17,31,36,[48][49][50]53,55,58,71,73,79,81 Only 14 articles (20%) mentioned health behaviour theories specific to their respective contracts (Box 2).12,17,31,36,[48][49][50]53,55,58,71,73,79,81 Contract implementation Only 11 articles (14%) mentioned or described training of health care professionals for the implementation ofBox 1. ...
Objective:
To describe how and why patient contracts are used for the management of chronic medical conditions.
Data sources:
A scoping review was conducted in the following databases: MEDLINE, Embase, AMED, PsycInfo, Cochrane Library, CINAHL, and Nursing & Allied Health. Literature from 1997 to 2017 was included.
Study selection:
Articles were included if they were written in English and described the implementation of a patient contract by a health care provider for the management of a chronic condition. Articles had to present an outcome as a result of using the contract or an intervention that included the contract.
Synthesis:
Of the 7528 articles found in the original search, 76 met the inclusion criteria for the final review. Multiple study types were included. Extensive variety in contract elements, target populations, clinical settings, and cointerventions was found. Purposes for initiating contracts included behaviour change and skill development, including goal development and problem solving; altering beliefs and knowledge, including motivation and perceived self-efficacy; improving interpersonal relationships and role clarification; improving quality and process of chronic care; and altering objective and subjective health indices. How contracts were developed, implemented, and assessed was inconsistently described.
Conclusion:
More research is required to determine whether the use of contracts is accomplishing their intended purposes. Questions remain regarding their rationale, development, and implementation.
... It was specifically designed to achieve a sustained increase in patients' PA levels and was based on the Social Cognitive Theory (SCT), 16 which acknowledges the role of self-efficacy, goal setting and performance feedback as core elements of behaviour change. The present intervention incorporated these concepts using the Health contract technique 17,18 and objective feedback provided by pedometers. The intervention is described in detail below. ...
... This technique has been applied with varied degrees of success in interventions conducted with other populations and health behaviours. 18,35,36 It has advantages over verbal communication alone, since formal commitment enhances the individual-clinician relationship and stimulates the active participation of the individual in identifying an achievable health goal and creating a behaviour change plan. 37 The costs associated with the addition of the PA-focused behavioural intervention to PR were relatively small and related to the purchase of pedometers and printed material (Health contract and calendar), the telephone calls and the time needed by the physiotherapist to provide support (approximately 20-30 minute/session). ...
The aim of this study was to investigate the impact of a physical activity (PA)-focused behavioural intervention during and after pulmonary rehabilitation (PR) on PA levels (primary aim), health-related outcomes and self-efficacy (secondary aims) of patients with COPD. Thirty-two patients were randomly assigned to an experimental group (EG) or control group (CG). The EG received a PA-focused behavioural intervention during PR (3 months) and follow-up support (3 months). The CG received PR (3 months). Daily PA was collected: number of steps; time spent in moderate-to-vigorous PA (MVPA), total PA and sedentary activities (SA). Secondary outcomes comprised exercise capacity, muscle strength, health-related quality of life (HRQOL) and self-efficacy. Measures were collected at baseline, 3 and 6 months. Compared with the CG, the EG improved the number of steps (p = 0.006) and time spent in MVPA (p = 0.007), total PA (p = 0.014) and SA (p = 0.018) at 3 months. Differences were maintained after follow-up support (0.025 ≤ p ≤ 0.040), except for SA (p = 0.781). Exercise capacity, muscle strength and HRQOL were increased at 3 and 6 months (p ≤ 0.002) with no between-group differences (0.148 ≤ p ≤ 0.987). No changes were observed in self-efficacy (p = 0.899). A PA-focused behavioural intervention during and after PR may improve patients' PA levels. Further research is warranted to assess the sustainability of the findings.
... The ParkFit program was specifically designed to achieve a sustained increase in the level of physical activity and was based both on theories and models of behavioral change [13,14] and on behavioral change techniques with proven effectiveness [15][16][17]. Models of behavioral change that were used for this program were the 'transtheoretical model of health behavior' and the social cognitive theories. ...
... Furthermore, suitable activities for PD patients, strategies to identify and overcome barriers to engage in physical activity, setting goals and recruiting social support were covered. The workbook included a health contract, a written agreement between patient and physiotherapist to support patients in initiating and maintaining physical activities by formulating long term activity goals [17]. Additionally, a logbook was included to monitor short term goals. ...
We recently completed the ParkFit study, a two-year randomized controlled trial including 586 sedentary Parkinson's disease (PD) patients, that evaluated a multifaceted intervention (ParkFit program) to promote physical activity. The results showed that the ParkFit program enables PD patients to become physically more active, suggesting that this intervention should now be further implemented into clinical practice. To facilitate this process, we here evaluate the implementation of the ParkFit program.
The ParkFit program was evaluated in three ways: (a) experiences of patients and physiotherapists, as investigated using interviews and questionnaires; (b) factors associated with changed activity levels; and (c) subgroup analyses to identify differential effects in subgroups of patients based on baseline physical activity level, age, gender, disease severity, disease duration, and mobility.
The ParkFit program was well received: 73% of patients indicated they would recommend the program to other patients, and 90% of physiotherapists indicated they wanted to use the ParkFit program in other patients. Multiple forward regression analysis resulted in a model with two variables: less baseline physical activity, and better mobility were associated with larger changes in levels of physical activity (R(2)=38%). The program was effective in almost all subgroups. In women, most sedentary patients and patients with higher disease severity, the estimated effect size was largest.
We conclude that the ParkFit program was effective in almost all specific subgroups. Therapists and patients experienced no major hurdles. Suggestions for improvement are: (1) improve education for therapists with respect to theories about behavioral change; (2) formulate concrete and specific examples of exercise goals; and (3) pay more specific attention to patients with co morbidities, cognitive dysfunction and a lack of motivation during education.
... 23 We developed such an intervention (the ParkFit programme 24 ) based on models of behavioural change and containing established behavioural change techniques. [25][26][27][28][29] To evaluate this programme, we designed a randomised controlled trial comparing ParkFit with a matched control intervention. 24 ...
... We designed the ParkFit programme specifically to achieve a sustained increase in physical activity levels, on the basis of theories and models of behavioural change and on effective behavioural change techniques. [25][26][27][28][29] Important elements were activity coaches who guided each patient towards a more active lifestyle during monthly personal coaching sessions; an educational brochure about the benefits of physical activity and suitable activities for patients with Parkinson's disease; identifying and overcoming any perceived barriers to engaging in physical activity; systematic goal setting, using a health contract and logbook; stimulation to participate in group exercises; and an ambulatory monitor with automated feedback reflecting actually delivered physical activities. 34 Ambulatory monitor data were uploaded to a personalised website, where both the patient and coach could monitor progress. ...
To evaluate whether a multifaceted behavioural change programme increases physical activities in patients with Parkinson's disease.
Multicentre randomised controlled trial.
32 community hospitals in the Netherlands, collaborating in a nationwide network (ParkinsonNet).
586 sedentary patients with idiopathic Parkinson's disease aged between 40 and 75 years with mild to moderate disease severity (Hoehn and Yahr stage ≤3).
Patients were randomly assigned to the ParkFit programme or a matched general physiotherapy intervention. ParkFit is a multifaceted behavioural change programme, designed specifically to achieve an enduring increase in the level of physical activity (coaches using motivational strategies; ambulatory feedback).
The primary endpoint was the level of physical activity, measured every six months with a standardised seven day recall (LASA physical activity questionnaire-LAPAQ). Secondary endpoints included two other measures of physical activity (activity diary and ambulatory activity monitor), quality of life (Parkinson's disease questionnaire-PDQ-39), and fitness (six minute walk test).
540 (92.2%) patients completed the primary outcome. During follow-up, overall time spent on physical activities (LAPAQ) was comparable between the groups (adjusted group difference 7%, 95% confidence interval -3 to 17%; P=0.19). Analyses of three secondary outcomes indicated increased physical activity in ParkFit patients, as suggested by the activity diary (difference 30%; P<0.001), the activity monitor (difference 12%; P<0.001), and the six minute walk test (difference 4.8 m; P=0.05). PDQ-39 did not differ between ParkFit patients and controls (difference -0.9 points; P=0.14). The number of fallers was comparable between ParkFit patients (184/299; 62%) and controls (191/287; 67%).
The ParkFit behavioural change programme did not increase overall physical activity, as measured with the LAPAQ. The analysis of the secondary endpoints justifies further work into the possible merits of behavioural change programmes to increase physical activities in daily life in Parkinson's disease.
Clinical trials NCT00748488.
... To właśnie wraz z wiekiem częściej pojawia się dbałość o zdrowie i sprawność fizyczną. Z badań wynika, iż motyw zdrowotny, jako najważniejszy z motywów, chociaż różnie określany -dbałość, troska o zdrowie, lepszy stan zdrowia, wartości, korzyści zdrowotne, motyw witalny był najczęściej wymienianym wśród uwarunkowań podejmowania aktywności fizycznej przez seniorów, zarówno kobiet, jak i mężczyzn (Baj-Korpak i in., 2013;Haber i Rhodes, 2004;Hirvensalo i in., 1998;Łysak i in., 2014;Makuła, 2009;Resnick, 2002). Motyw zdrowotny był też szczególnie podkreślany przez osoby z chorobami przewlekłymi. ...
Seniorzy stanowią najszybciej rosnącą grupę populacji w rozwiniętych krajach. Jednak zwiększaniu się długości życia nie zawsze towarzyszy poprawa jakości życia. Dlatego istotną kwestią, również u osób starszych jest prowadzenie prozdrowotnego stylu życia, w którym ważne miejsce powinna zajmować aktywność fizyczna. Jest to element konieczny do zachowania sprawności fizycznej i funkcjonalnej, dobrego stanu zdrowia, także autonomii i niezależności. W niniejszej publikacji znajdują się treści dotyczące procesu starzenia, form jego przebiegu i obserwowane zmiany inwolucyjne w poszczególnych układach organizmu człowieka. Scharakteryzowano korzyści wynikające z regularnego podejmowania aktywności fizycznej, szczególnie w odniesieniu do osób starszych. Zaprezentowane zostały rekomendacje dotyczące odpowiedniej dla zdrowia „dawki” wysiłku fizycznego, opisano zasady ćwiczeń powalające bezpiecznie i zdrowo ćwiczyć oraz zaproponowano formy aktywności fizycznej dla osób dojrzałych i starszych.
Książka pierwotnie dostępna w kolekcji Śląskiej Biblioteki Cyfrowej: https://sbc.org.pl/publication/579971#description
... Older adults often cite health benefits as the main reason to be physically active (Baert, Gorus, Mets, Geerts, & Bautmans, 2011;Schutzer & Graves, 2004). They believe it will contribute to independent living (Crombie et al., 2004;Haber & Rhodes, 2004;Mehra et al., 2016). Likewise, social interactions with others is frequently cited as a motivator. ...
A Phenomenological Exploration of Autonomy and Related
Psychological Needs Among the Residents of a Memory
Care Unit .
... Based on a substantive body of research, health care providers are increasingly prescribing exercise programs to older adults for both preventive and rehabilitative medical issues (Geithner & McKenney, 2010;Haber & Rhodes, 2004;Katula, Sipe, Rejeski, & Focht, 2004;McDermott & Mernitz, 2006;Nelson et al., 2007;Schutzer & Graves, 2004;Thurston & Green, 2004). Although it has become common practice to recommend exercise for health benefits, the problem of compliance is paramount (Kruger et al., 2008;Lee et al., 2000). ...
Caregiver religiosity and exercise are aspects often overlooked by dementia research while remaining important factors within the dementia caregiver experience. As a result of prior qualitative research findings, the author focused on religious components of the caregiving process in addition to exercise and various caregiver perceptions. Data was collected on the characteristics of 31 spouse and adult-child caregivers of patients diagnosed with Alzheimer's disease. Questionnaire data provide the basis for a descriptive model for patient and caregiver (prior and current) religious needs. The data suggest subjects who indicate less involvement in organized and non-organized religious activity tend to report higher levels of overall burden F (4,30) = 2.89, p < .05. In addition, variables associated with exercise predict total caregiver burden F (3, 29) = 4.5, p < .01. The present findings suggest that a lack of involvement in organized and non-organized religious activity, as well as a lack of exercise during the caregiving period, predicts higher levels of burden.
... Therefore, memory cues can be a powerful tool to remind an individual to engage in the new behavior. 72 For example, placing eating plans on the refrigerator or walking shoes by the front door. ...
Nonalcoholic fatty liver disease (NAFLD) is frequently concomitant with obesity. This article discusses factors that influence health and functional outcomes of people who develop NAFLD, including increased burden of illness, whole body function, performance, and perception of self-efficacy. Changes in macronutrients, amount of calories consumed, and decreased physical activity all negatively influence patient outcome. The benefits of exercise in this population are also discussed. To be effective, exercise must be performed, regularly and in conjunction with dietary and other behavioral change. Therefore, a lifelong commitment to exercise, activity, and diet are needed if NAFLD is to be successfully treated.
... When developing interventions for seniors, their special characteristics must be considered [16]. Including them in the program development and embracing their perceptions and experiences are likely to improve the success of interventions [17]. ...
... Based on a substantive body of research, health care providers are increasingly prescribing exercise programs to older adults for both preventive and rehabilitative medical issues (Geithner & McKenney, 2010;Haber & Rhodes, 2004;Katula, Sipe, Rejeski, & Focht, 2004;McDermott & Mernitz, 2006;Nelson et al., 2007;Schutzer & Graves, 2004;Thurston & Green, 2004). Although it has become common practice to recommend exercise for health benefits, the problem of compliance is paramount (Kruger et al., 2008;Lee et al., 2000). ...
A predominate motivation theory used to predict exercise behavior is self-determination theory, which posits that motivation is driven by satisfaction of three basic psychological needs: autonomy, competence, and relatedness. This study investigates the relationship between motivation, basic psychological needs satisfaction, and exercise in a sample of older adults. Significant differences were found between older adult exercisers and nonexercisers in intrinsic motivation, self-determined extrinsic motivation, nonself-determined extrinsic motivation, autonomy, competence, and relatedness. This study suggests that self-determination theory is a suitable framework to investigate older adult exercise behaviors.
... Interventions that aim to promote both physical activity and healthy nutrition in older adults have identified the effectiveness of written information for promoting behaviour change [25,26]. Specific health contracts involving both the health professional and the participant are found to induce positive changes in physical activity and nutrition behaviour [27]. Health log books, where older adults identify health concerns and record how they can be addressed, have encouraged the adoption of health enhancing behaviours [28]. ...
Objective. To evaluate the effectiveness of a 12-week home-based postal and telephone physical activity and nutrition pilot program for seniors. Methods. The program was delivered by mailed material and telephone calls. The main intervention consisted of a booklet tailored for seniors containing information on dietary guidelines, recommended physical activity levels, and goal setting. Dietary and walking activity outcomes were collected via a self-administered postal questionnaire pre-and postintervention and analysed using linear mixed regressions. Of the 270 seniors recruited, half were randomly selected for the program while others served as the control group. Results. The program elicited favourable responses. Postintervention walking for exercise/recreation showed an average gain of 27 minutes per week for the participants in contrast to an average drop of 5 minutes for the controls (P < .01). Little change was evident in errand walking for both groups. The intervention group (n = 114) demonstrated a significant increase in fibre intake (P < .01) but no reduction in fat intake (P > .05) compared to controls (n = 134). Conclusions. The participants became more aware of their health and wellbeing after the pilot program, which was successful in increasing time spent walking for recreation and improving fibre intake.
... As can be seen in Table 4, 21 studies did not use a theoretical framework to categorize the nature of motivators and barriers for PA. Seven studies used the Social Cognitive Theory (Casado et al., 2009;Damush et al., 2005;Dye and Wilcox, 2006;Haber and Rhodes, 2004;Mihalko et al., 2006;Wilcox et al., 2003). One study used a combination of the Social Cognitive Theory and the Transtheoretical Model of Behavior of Change (Cousins, 2003). ...
Worldwide, people engage insufficiently in physical activity, particularly subjects aged 80 years and over. For optimal life-style campaigns, knowledge of motivators and barriers for physical activity is mandatory. Given their specific needs, it is conceivable that these would be different for the oldest old compared to younger subjects. Pubmed, Web of Science and Psychinfo were systematically screened for articles reporting motivators and barriers for physical activity. Papers were excluded if data regarding elderly aged >79 years were absent. Forty-four relevant articles were included, involving a total of 28,583 subjects. Sixty one motivators and 59 barriers for physical activity in the elderly were identified, including those who are relevant for persons aged 80 years and over. Based on the results of our literature review, we recommend that when promoting physical activity in the oldest old, special attention is paid to the health benefits of physical activity, to the subject's fears, individual preferences and social support, and to constraints related to the physical environment. However, no studies were found exclusively describing people aged 80 years and over, and future research is necessary to differentiate the barriers or motivators that are specific for the oldest old from those of younger elderly.
... Interventions that aim to promote both physical activity and healthy nutrition in older adults have identified the effectiveness of written information for promoting behaviour change [25, 26]. Specific health contracts involving both the health professional and the participant are found to induce positive changes in physical activity and nutrition behaviour [27]. Health log books, where older adults identify health concerns and record how they can be addressed, have encouraged the adoption of health enhancing behaviours [28]. ...
... Interventions that aim to promote both physical activity and healthy nutrition in older adults have identified the effectiveness of written information for promoting behaviour change [25, 26]. Specific health contracts involving both the health professional and the participant are found to induce positive changes in physical activity and nutrition behaviour [27]. Health log books, where older adults identify health concerns and record how they can be addressed, have encouraged the adoption of health enhancing behaviours [28]. ...
Objective. To evaluate the effectiveness of a 12-week home-based postal and telephone physical activity and nutrition pilot program for seniors.
Methods. The program was delivered by mailed material and telephone calls. The main intervention consisted of a booklet tailored for seniors containing information on dietary guidelines, recommended physical activity levels, and goal setting. Dietary and walking activity outcomes were collected via a self-administered postal questionnaire pre- and postintervention and analysed using linear mixed regressions. Of the 270 seniors recruited, half were randomly selected for the program while others served as the control group.
Results. The program elicited favourable responses. Postintervention walking for exercise/recreation showed an average gain of 27 minutes per week for the participants in contrast to an average drop of 5 minutes for the controls (P < .01). Little change was evident in errand walking for both groups. The intervention group (n = 114) demonstrated a significant increase in fibre intake (P < .01) but no reduction in fat intake (P > .05) compared to controls (n = 134).
Conclusions. The participants became more aware of their health and wellbeing after the pilot program, which was successful in increasing time spent walking for recreation and improving fibre intake.
... Goal setting has also been associated with improvements in physical activity. [20][21][22] Evidence also suggests that the use of a pedometer is associated with a significant increase in physical activity. 23,24 Because selfmonitoring and performance feedback are well-validated techniques to create habitual behaviors, we offer a pedometer and step calendar to treatment group participants on which to record their daily step counts and their thoughts about physical activity. ...
Despite recent studies showing the benefit of physical activity for people with arthritis, the vast majority of persons with arthritis are not sufficiently physically active. The purpose of this report is to describe a tailored health promotion intervention aimed at increasing physical activity among persons with arthritis. The intervention is designed to be useful for health systems and insurers interested in a chronic disease management program that could be disseminated to large populations of arthritis patients.
The intervention is carried out by a clinician who is designated as the client's physical activity advocate. The approach emphasizes motivational interviewing, individualized goal setting, tailored strategies for increasing physical activity and for monitoring progress, and a plan of 2 years of follow-up. The intervention includes a standardized assessment of barriers to and strengths supporting increased lifestyle physical activity. A randomized, controlled trial is underway to evaluate the efficacy and cost-effectiveness of this intervention.
This intervention is unique in that it implements a program tailored to the individual that focuses on lifestyle physical activity and long-term monitoring. The approach recognizes that persons with arthritis present with varying levels of motivation for change in physical activity and that behavior change can take a long time to become habitual.
... When developing interventions for seniors, their special characteristics must be considered [16]. Including them in the program development and embracing their perceptions and experiences are likely to improve the success of interventions [17]. In this study, the Physical Activity and Nutrition for Seniors (PANS) program was developed based on a participatory action research (PAR) approach, in which a mailed booklet supported by telephone calls formed the main intervention. ...
Background
This paper describes the development and process evaluation of an interactive booklet aimed at motivating older adults to improve their nutrition and physical activity.
Findings
The booklet was developed in consultation with seniors via focus groups, individual interviews and self administered questionnaires. The booklet was disseminated to a group of 114 seniors as the main component of a 12-week intervention program. Process evaluation was conducted during and at the end of the intervention period.
A large proportion of participants (86%) were engaged in the program in that they had, as a minimum, read the booklet. The majority of the participants found the booklet provided them with useful and interesting advice in an easy-to-read and informative manner. Three quarters (76%) reported the materials to be motivating and increased their awareness of nutrition and physical activity, while 79% intended to continue with changes to their physical activity and diet after the program concluded.
Aging is associated with a decline in the ability to carry out daily tasks. Physical activity can delay or diminish the decline and increase the ability of older adults to live independently at home. Performing home-based exercises can help older adults achieve the recommended levels of physical activity. Technology allows exercise programs to be tailored to individual needs. This thesis describes a blended intervention that was developed and evaluated according to the Medical Research Council framework. The principal findings are that older adults are motivated to perform technology-supported home-based exercises if they help them maintain self-reliance and there is sufficient guidance, safety is taken into account, and adherence is stimulated. To meet those conditions, a blended intervention was developed that was based on functional exercises, behavior change theory and human guidance. A custom-made tablet application appears to be usable by the target audience. A process evaluation has shown that the tablet as well as the coach support older adults in the various phases of self-regulating their exercise behavior. The blended intervention stimulates intrinsic motivation by supporting the autonomy of participants, fostering competence and, for some, meeting the need for relatedness by offering emotional support. Data derived from the tablet demonstrate that older adults participating in the intervention exhibit exercise behavior that is in line with WHO guidelines and that engagement with the tablet was a contributing factor. Future work should include assessment of intervention fidelity and explore which aspects of coaching can and cannot be further automated.
Physical activity (PA) and social support have known benefits for the well-being and health of older adults, and social support is associated with PA behavior and positive affective experiences in PA contexts. The aim of this study was to synthesize qualitative research conducted on the experiences of social support related to PA among older adults (age ≥55 years). Following meta-study methodology, the authors searched nine databases and extracted information from 31 studies. Results were synthesized in terms of common themes and in light of theoretical and methodological perspectives used. The qualitative literature identifies supportive behaviors and social network outcomes which may be useful for informing how best to support older adults to be physically active. This literature rarely reflected the experiences of vulnerable populations, and future research should aim to further understand supportive behaviors which enable older adults to overcome barriers and challenges to being physically active.
Physical activity can prolong the ability of older adults to live independently at home. A blended intervention was developed to sustain healthy aging. During a clinical trial 133 participants, with an average age of 71 years old, received a tablet and coaching to support them in performing home-based exercises for 6 months. To investigate how the blended intervention influenced exercise motivation, 17 participants were interviewed. Transcripts were analyzed according to the directed content analysis method. The analysis revealed that the intervention supported the autonomy of participants, by letting them set their own personal goals and compile a personalized exercise program. It also supported their feelings of competence, by offering clear instructions, structure, and the ability to track their progress. Finally, some participants valued the emotional support offered by the personal coach, while others preferred combining the home-based exercises with group-based activities with peers to fulfill their relatedness needs.
Despite the information available about the benefits of physical activity, many older adults are not participating in sufficient physical activity to influence their quality of life positively. Activity professionals frequently intervene to change this behavior with less than optimal results. This paper provides a framework to approach changing activity levels by intervening with older adults according to their stage of readiness for change, rather than using a one-sizefitsall approach. The Stages of Motivational Readiness for Change Model is discussed followed by suggestions for interventions at each stage.
The purpose of this qualitative study was to examine perceptions held by recipients of adult day services about the impact of intergenerational programming on their emotional well-being. Thirteen recipients of adult day services in a center that provided intergenerational programming participated in guided interviews. These interviews were transcribed and coded for emerging themes. Themes were contextualized in terms of the degree of involvement among study participants. Major themes included peer support, youth and enthusiasm, freedom of choice, familial connections, and being needed. Participants reported overwhelmingly positive experiences in regards to intergenerational programming. Implications for practice include validating the importance of older adults' contributions, encouraging familial connections, and allowing participants to choose their own level of involvement.
A cluster randomized study was conducted using a convenience sample of four Christian faith communities from which 27 African American women 60 and older were recruited. The purpose was to determine whether African American women receiving a physical activity intervention with spiritual strategies compared to a control group would demonstrate differences over time in physical activity behaviors and biomarkers, in self-efficacy for physical activity, and in barriers to physical activity. Results with baseline and 12-week measurements included significant between-group findings at 12 weeks on muscle strength activity (minutes per week, z = -3.269, p = 0.001; days per week, z = -3.384, p = 0.001), favoring the intervention group. There were significant between-group findings in 6-minute walk change scores (z = -2.546, p = 0.009), favoring the intervention group. Barriers were significantly reduced within the intervention group (z = -2.184, p = 0.029). Evidence suggests a physical activity intervention with spiritual strategies increases physical activity behavior. The Health Promotion Model can be used to develop physical activity interventions with spiritual strategies for older African American women in faith communities, thus, supporting Healthy People 2020 goals.
Objectives:
To provide a brief overview of published immunosuppressant therapy (IST) adherence interventions in adult renal transplant recipients (RTRs) and to describe the utility and aspects of an adherence toolbox for adult RTRs.
Setting:
National independent specialty pharmacy.
Practice description:
IST adherence is critical to graft survival after a renal transplant. However, IST nonadherence occurs in a large proportion of adult RTRs. Although effective intervention strategies are needed to improve IST adherence, few intervention studies have been conducted in the adult RTR population. To address this gap in the literature, a randomized controlled trial of a patient-specific behavioral contracts intervention to improve IST adherence among adult RTRs has been implemented.
Practice innovation:
During the behavioral contracts intervention, researchers have developed a toolbox of practical and replicable items and strategies to address forgetfulness and confusion as barriers to IST adherence.
Conclusion:
An adherence toolbox that includes simple, practical, accessible mechanisms and strategies to improve IST adherence may benefit adult RTRs.
To characterize how the use of behavioral contracts may serve to focus individuals' intentions to grow as leaders.
Between 2007 and 2008, participants of the Society of Hospital Medicine Leadership Academy courses completed behavioral contracts to identify 4 action plans they wanted to implement based on things learned at the Academy. Contracts were independently coded by 2 investigators and compared for agreement. Content analysis identified several major themes that relate to professional growth as leaders. Follow-up surveys assessed fulfillment of personal goals.
The majority of respondents were male (84; 70.0%), and most were hospitalist leaders (76; 63.3%). Their median time practicing as hospitalists was 4 years, 14 (11.7%) were Assistant Professors, and 80 (66.7%) were in private practice. Eight themes emerged from the behavioral contracts, revealing ways in which participants wished to develop: improving communication and interpersonal relations; refining vision and goals for strategic planning; developing intrapersonal leadership; enhancing negotiation skills; committing to organizational change; understanding business drivers; establishing better metrics to assess performance; and strengthening interdepartmental relationships. At follow-up, all but 1 participant had achieved at least 1 of their personal goals.
Understanding the areas that hospitalist leaders identify as "learning edges" may inform the personal learning plans of those hoping to take on leadership roles in hospital medicine.
Social support is an important resource for chronic disease management. However, it is not routinely assessed in the context of caring for patients with cardiovascular disease or as part of the cardiovascular rehabilitation process. The objective was to develop a survey designed to measure the types of social support that are necessary in cardiovascular disease prevention and management.
Items were derived based on qualitative interviews with 63 patients regarding their perception of the most helpful types of social support in health behavior modification. Test-retest reliability was determined among 43 new patients. Factor analysis was conducted to determine the structural domains of the survey. The survey was then validated against the Medical Outcomes Study Social Support Survey in 130 patients.
The survey used, which was called Tangible, Informational, and Emotional Social Support Survey, contains 16 items that explore tangible, informational, and emotional social support. Cronbach coefficient was .80. Exploratory factor analysis revealed a 4-factor solution, which accounted for 54% of the total variance. Patients who were married had higher scores (P < .05), compared with those who were not and scores on Tangible, Informational, and Emotional Social Support Survey correlated with the scores on the Medical Outcomes Study Social Support Survey (r = 0.82).
Tangible, Informational, and Emotional Social Support Survey is a patient-derived, reliable, and valid social support survey. It can be used to capture salient aspects of social support that may facilitate health behavior modification in cardiovascular disease patients.
We hypothesized that a cardiologist-initiated motivational discussion during a routine general cardiology clinic visit that included an exercise 'contract' signed by the patient, physician and a witness, would increase self-reported days per week of exercise.
A short-term pilot intervention was provided to forty consecutive general cardiology clinic patients who were enrolled in 2005. They were asked to answer the question "How many days each week do you exercise" prior to the motivational discussion and at routine follow-up. Each participant signed an exercise 'contract' and agreed to exercise for at least 15 min everyday.
Participants had an average follow-up of 3.2 (1.7) months. The initial visit mean days of exercise per week were 3.1 (1.9). At follow-up, mean days of exercise per week were 4.0 (1.8), (p=0.04).
This simple rapid intervention was associated with increased self-reported days per week of exercise.
A health contract is a technique used by health professionals to help clients achieve a health goal. This article describes a course, "Changing Health Behaviors," in which a health contract strategy is taught and practiced with older adults. The health contract can also be included as a smaller educational component within a gerontology course that covers risk factors such as sedentary behavior or nutritional deficiency, counseling or health education techniques, or program development. Gerontology students who complete a degree or certificate program may enter a variety of venues in which a health contract can be a useful tool with older clients.
Immunosuppression adherence among kidney transplant recipients is essential for graft survival. However, nonadherence is common, jeopardizing graft survival. Besides skipping dosages, little is known about other forms of medication nonadherence and their underlying reasons. This study sought to examine patients' extent of medication adherence over time and reasons for nonadherence. Thirty-nine new kidney transplant recipients were asked to complete a month-long medication-taking diary that included reporting medication nonadherence such as skipped medications, medications taken early or late, taking dosages greater or less than prescribed, and the reason for each occurrence of nonadherence. Of the 20 (51%) patients who completed the diary, 11 (55%) reported at least 1 form of nonadherence. Eleven patients reported taking their immunosuppression at least 1 hour later than the prescribed time, 1 patient reported skipping medication, but no patients reported changing the dosage on their own. Immunosuppression was taken on average 1.5 hours after the prescribed time. Of those patients who took their medications late, there were on average 3.1 occasions of taking it late. The most common reasons for this behavior included health care-related issues, followed by oversleeping, being away from home, work-related barriers, and forgetting. The majority of kidney transplant recipients took medications later than prescribed during 1 month. Future research should determine the clinical impact on graft function of late administration of immunosuppression. Interventions should be designed to better assist kidney recipients with taking medications on time, especially when they are away from home.
Organizes evidence around adherence models of exercise behavior that consider the exerciser, the exercise setting, and the person–setting interaction in order to determine factors that cause recidivism in exercise programs. The psychology, biology, and history/background of the exerciser are reviewed. Addiction/dependence and stage theory are discussed with regard to the person–setting interaction. Also illustrated are the predictive limitations of studies that have focused solely on screening and diagnosis or on intervention and control rather than on a strategy combining both approaches. The timeliness of controlled research on exercise adherence is reinforced by the growing use of various interventions for the enhancement of exercise behavior in clinical settings and by similarities between adherence to health-related exercise and compliance with other types of medical prescriptions. (108 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article presents a model of case management with rural clients entering drug and alcohol treatment. As part of a larger treatment protocol called Structured Behavioral Outpatient Rural Therapy, behavioral contracting is combined with strengths perspective case management to help rural clients motivate themselves to engage and complete drug and alcohol treatment. This combined approach is designed to continually communicate and teach an "A-B-C" cognitive-behavioral approach to problem-solving and change. While not a panacea for addressing the myriad problems facing clients with drug use problems, such an approach promises to improve "treatment as usual" formats, which often ignore the formidable obstacles to human change experienced by rural clients and clinicians.
Physical inactivity is a health concern in the United States with nearly 70% of the population getting inadequate amounts of exercise. We set out to determine if wearing a pedometer could significantly increase awareness and amount of physical activity among female employees at a large health care setting.
Employees purchased a pedometer, completed a survey, and were encouraged to walk 10,000 steps daily. Eight weeks later, they completed a follow-up survey.
Initially, 510 employees initially participated. Results from 400 women are reported. Setting daily step goals, keeping a log of steps walked, and wearing the pedometer all the time were the indicators most likely to predict significant improvements in level of awareness and amount of physical activity, self-efficacy, and other physical improvements (increased energy, ill less often, and weight loss). A majority (71%) indicated they would continue to wear the pedometer after the study ended.
Wearing a pedometer is a simple, non-invasive way for women to increase awareness of daily activity and does lead to increased physical activity. Maximum results in improved activity and improvement in health occurred in women who were most compliant with the intervention.
Self-management techniques improve compliance with health programs although their efficacy in exercise rehabilitation programs for patients with coronary heart disease (CHD) is not known. Men with CHD (N = 120) were referred to a six-month exercise program in which they were stratified and randomly allocated to either a control group (N = 57) or an experimental group (N = 63). Control group patients received standard treatment; experimental group patients were asked to sign an agreement to comply for six months and to record in diaries the following information: (1) self-monitored heart rate response to sub-maximal exercise tests, (2) daily physical activity levels, and (3) weight changes and smoking habits. Compliance in the control group was 42% and in the experimental group 54% (NS). However, the 65% compliance rate in the 48 experimental group subjects who had signed the compliance agreement was significantly higher than the 20% compliance rate in the 15 experimental group subjects who had not signed the agreement (P < .005) and was higher than the 42% compliance rate in the control group (P < .01). Self-monitored heart rate response was the item most frequently recorded in diaries. Dropout rates were significantly higher (P < .01) in smokers, in blue collar workers, and in those with inactive leisure habits; younger age was also associated with dropout. The higher compliance rates in those who signed the agreement to comply reinforces the need for further investigation of self-management compliance-improving strategies.
1. Exercise of personal and collective efficacy in changing societies Albert Bandura 2. Life trajectories in changing societies Glen Elder 3. Developmental analysis of control beliefs August Flammer 4. Impact of family processes on self-efficacy Klaus A. Schneewind 5. Cross-cultural perspectives on self-efficacy beliefs Gabriele Oettingen 6. Self-efficacy in educational development Barry Zimmerman 7. Self-efficacy in career choice and development Gail Hackett 8. Self efficacy and health Ralf Schwarzer and Reinhard Fuchs 9. Self-efficacy and alcohol and drug abuse Alan Marlatt, John S. Baer and Lori A. Quigley.
This article presents a model of case management with rural clients entering drug and alcohol treatment. As part of a larger treatment protocol called Structured Behavioral Outpatient Rural Therapy, behavioral contracting is combined with strengths perspective case management to help rural clients motivate themselves to engage and complete drug and alcohol treatment. This combined approach is designed to continually communicate and teach an “A-B-C” cognitive-behavioral approach to problem-solving and change. While not a panacea for addressing the myriad problems facing clients with drug use problems, such an approach promises to improve “treatment as usual” formats, which often ignore the formidable obstacles to human change experienced by rural clients and clinicians.
Discusses the use of health contracts (HCs), which are based on a self-management version of social learning theory (which states that patients can monitor a health behavior goal and provide self-rewards that will increase their probability of achieving the goal). Among the advantages of an HC are that it is a written commitment that enhances motivation and that it enhances the therapeutic relationship between provider and client. In a health education class, 85 elderly Ss (mean age 69 yrs) reported a positive experience with the HC or at least partial goal achievement. This represented an 80% success rate. Of 67 respondents (mean age 55 yrs) to a questionnaire on their use of the HC, 16–25% of laypersons and 10% of health professionals followed through on the HC and at least partially achieved their health goal. The successful completion of the contract was reduced from 80% to 25% when it was mailed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
4 factors are essential to learning: drives, cues, responses, and rewards. Social motivations which are secondary drives include imitativeness, a process by which matched acts are evoked in two people and connected to appropriate cues. "In
matched-dependent behavior, the leader is able to read the relevant environmental cue, but the follower is not; the latter must depend upon the leader for the signal as to what act is to be performed and where and when." In copying behavior "the copier must slowly bring his response to approximate that of a model and must know, when he has done so, that his act is an acceptable reproduction of the model act." The authors present not only a theoretical analysis of these problems but also experiments on rats and children where the problem has been to teach the subject to imitate. There is a discussion of crowd behavior, an analysis of a case of lynching, and a discussion of the diffusion of culture. Appendices present a revision of Holt's theory of imitation and a historical review of the general topic. "Our position is that if there are any innate connections between stimuli and responses of the initiative type, they are few and isolated." "In summary, imitation can greatly hasten the process of independent learning by enabling the subject to perform the first correct response sooner than he otherwise would… . In order for imitation to elicit the first correct response, the essential units of copying or matched-dependent behavior must already have been learned." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study was designed to assess the effect of contingency contracting on adherence (attendance), and on patients' knowledge of the physiological principles and parameters of exercise essential for a safe exercise regimen during and following an outpatient cardiac rehabilitation program. Twentyeight patients referred for cardiac rehabilitation were alternately assigned to either a standard treatment or contingency contracting group. Both groups received one hour per week of formal education in a group setting. Weekly contingency contracts were negotiated with patients in the contracting group for eight consecutive weeks. Changes in knowledge were assessed by means of a 16-item, written examination (Exercise Knowledge Test) administered at program initiation, 4 weeks and 8 weeks. A repeated measures analysis of variance design of knowledge test scores showed significantly greater gains in knowledge in the contracting group. There were no significant differences in attendance between groups. The results of this study suggested that the contingency contracting process may be an educational intervention worthy of consideration, in addition to traditional group lectures.
Behavioural contracting is an intervention technique in which a client signs an agreement to make certain behaviour changes within a specified time, usually with explicitly defined rewards for adherence or success. Contracting is being increasingly used by health professionals to assist patients in making beneficial life style changes. This paper presents data on the outcome of behavioural contracting interventions to lower serum cholesterol and to increase exercise activity. Of 223 primary care patients enrolled in a health promotion programme, 179 met with the project health educator to improve their cardiovascular risk profile; 144 of these were classified as having 'high cholesterol' and 51 signed contracts to adopt the American Heart Association guidelines diet within a 3-month period. Everyone was encouraged to sign a contract to engage in aerobic exercise three times per week; 96 did so. The results indicate that contractors achieved greater beneficial health changes than non-contractors, and that the group which fully met their contract obligations experienced the greatest health benefit of all (either a lowering of cholesterol or a decreased exercising heart rate).
The relation between health and a sense of control may grow stronger in old age. This could occur through three types of processes: experiences particularly relevant to control may increase markedly in old age; the association between control and some aspect of health may be altered by age; and age may influence the association between control and health-related behaviors or the seeking of medical care. Studies show that there are detrimental effects on the health of older people when their control of their activities is restricted; in contrast, interventions that enhance options for control by nursing home patients promote health. With increasing age, however, variability in preferred amounts of control also increases, and sometimes greater control over activities, circumstances, or health has negative consequences including stress, worry, and self-blame. Mechanisms mediating the control-health relation include feelings of stress, symptom labeling, changes in the neuroendocrine and immune systems, and behavior relevant to health maintenance.
There is a great demand for perceptual effort ratings in order to better understand man at work. Such ratings are important complements to behavioral and physiological measurements of physical performance and work capacity. This is true for both theoretical analysis and application in medicine, human factors, and sports. Perceptual estimates, obtained by psychophysical ratio-scaling methods, are valid when describing general perceptual variation, but category methods are more useful in several applied situations when differences between individuals are described. A presentation is made of ratio-scaling methods, category methods, especially the Borg Scale for ratings of perceived exertion, and a new method that combines the category method with ratio properties. Some of the advantages and disadvantages of the different methods are discussed in both theoretical-psychophysical and psychophysiological frames of reference.
The telephone is being widely used by the private sector as a communication medium for understanding and influencing consumer behavior. Coinciding with the growth of telephone use in the private sector is the expansion of telephone use in health care to include complex health promotion and disease prevention interventions aimed at initiating and maintaining health-related behavioral changes. While several studies have evaluated the impact of telephone interventions on a wide range of health behaviors, no published reports synthesizing current knowledge about using the telephone as a communication medium for health education were identified. In this article, the authors therefore (1) examine recent applications of telephone use in health education by describing three example interventions, (2) outline key features and alternatives in conceptualizing and designing health education using the telephone, (3) review advantages and disadvantages of using the telephone for health education, and (4) discuss implications for health education practice and research.
The purpose of this study was to determine whether written advice from general practitioners increases physical activity among sedentary people more than verbal advice alone.
Sedentary patients (n = 456) received verbal advice on increasing physical activity and were then randomized to an exercise prescription (green prescription) group or a verbal advice group.
The number of people engaging in any recreational physical activity at 6 weeks increased substantially, but significantly more so in the green prescription group. Also, more participants in the green prescription group increased their activity over the period.
A written goal-oriented exercise prescription, in addition to verbal advice, is a useful tool for general practitioners in motivating their parents to increase physical activity.
The purpose of this study was to use existing data to describe the behaviors performed by 117 subjects with Type II diabetes who wrote contingency contracts with nurses. Data were analyzed from a larger, randomized clinical trial of contingency contracting to improve clinical outcomes. Subjects had a high rate of completion of behaviors in contingency contracts (M = 90.9%). Subjects performed a median of six behaviors overall and up to a median of three behaviors of each of the diabetic regimen behaviors. The majority performed diet (n = 68, 58.1%) and exercise (n = 69, 58.9%) behaviors, with only one third performing both behaviors (n = 40, 34.2%). The most frequent behavioral strategies used were breaking the behavior into steps and self-monitoring the behavior. The contingency contracting intervention should be modified to be more comprehensive with increased recognition of the time and effort required for concurrently changing diet and exercise.
This investigation determined whether an in-home resistance training program achieved health benefits in older adults with disabilities.
A randomized controlled trial compared the effects of assigning 215 older persons to either a home-based resistance exercise training group or a waiting list control group. Assessments were conducted at baseline and at 3 and 6 months following randomization. The program consisted of videotaped exercise routines performed with elastic bands of varying thickness.
High rates of exercise adherence were achieved, with 89% of the recommended exercise sessions performed over 6 months. Relative to controls, subjects who participated in the program achieved statistically significant lower extremity strength improvements of 6% to 12%, a 20% improvement in tandem gait, and a 15% to 18% reduction in physical and overall disability at the 6-month follow-up. No adverse health effects were encountered.
These findings provide important evidence that home-based resistance exercise programs designed for older persons with disabilities hold promise as an effective public health strategy.
A modification of the health contract technique was applied by 4 geriatric fellows from the Center on Aging, University of
Texas Medical Branch, and 3 family medicine residents from the Department of Family Medicine, University of Texas Medical
Branch, to a diverse group of 48 older adults. The innovation, a calendar component to the health contract, allowed for the
calculation of specific success rates. Fifteen clients had a 100% success rate, and 21 were highly successful, 8 not too successful,
and 4 unsuccessful.
Back pain is a significant health care problem that has been managed unsatisfactorily in primary care settings. Providers typically address medical issues but do not adequately address patient concerns or functional limitations related to back pain. We evaluated a brief intervention for primary care back pain patients designed to provide accurate information about back pain, instill attitudes favorable towards self care, reduce fears and worries, assist patients in developing personalized action plans to manage their back pain, and improve functional outcomes. Patients enrolled in a large health maintenance organization were invited to participate in an educational program to improve back pain self care skills 6-8 weeks after a primary care back pain visit. Patients (n=226) were randomly assigned to a Self Care intervention or to Usual Care, and were assessed at baseline, 3-, 6-, and 12-months. The intervention involved a two-session Self Care group and an individual meeting and telephone conversation with the group leader, a psychologist experienced in chronic pain management. The intervention was supplemented by educational materials (book and videos) supporting active management of back pain. The control group received usual care supplemented by a book on back pain care. Participants assigned to the Self Care intervention showed significantly greater reductions in back-related worry and fear-avoidance beliefs than the control group. Modest, but statistically significant, effects on pain ratings and interference with activities were also observed.
For many years, behavioral contingency contracting has been useful in increasing compliance in a variety of patient populations. More recently, this type of contracting has been used to facilitate communication and motivate behavioral change among patients referred for transplantation. This article discusses the theoretical basis of behavioral contingency contracting and describes the development and implementation of a multipurpose behavioral contract for patients receiving heart transplants. The scarcity of donor organs and the stringent posttransplant regimen mandates that psychosocial as well as medical variables be considered during the transplant evaluation process. Behavioral contingency contracting is useful in identifying those individuals with the potential to maintain a transplanted organ capably.
Self-efficacy in changing societies Psychophysical bases of perceived exertion
- A Bandura
- G Borg
Bandura, A. (1997). Self-efficacy in changing societies. Cambridge, England: Cambridge University Press. Borg, G. (1982). Psychophysical bases of perceived exertion. Medicine and Science in Sports and Exercise, 14, 377–381.
Health behavior and health education: Theory, research, and practice
- K Glanz
- K Lewis
- B Rimer
Glanz, K., Lewis, K., Rimer, B. (1997). Health behavior and health education:
Theory, research, and practice. San Francisco: Jossey-Bass.