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Desta R, Blumrosen C, Laferriere HE, Saluja A, Bruce MA, Elasy TA, Griffith DM, Norris KC, Cavanaugh KL, Umeukeje EM. Interventions Incorporating Therapeutic Alliance to Improve Medication Adherence in Black Patients with Diabetes, Hypertension and Kidney Disease: A Systematic Review. Patient Prefer Adherence 2022; 16:3095-3110. [PMID: 36404799 PMCID: PMC9673796 DOI: 10.2147/ppa.s371162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Black Americans have a disproportionately increased risk of diabetes, hypertension, and kidney disease, and higher associated morbidity, mortality, and hospitalization rates than their White peers. Structural racism amplifies these disparities, and negatively impacts self-care including medication adherence, critical to chronic disease management. Systematic evidence of successful interventions to improve medication adherence in Black patients with diabetes, hypertension, and kidney disease is lacking. Knowledge of the impact of therapeutic alliance, ie, the unique relationship between patients and providers, which optimizes outcomes especially for minority populations, is unclear. The role and application of behavioral theories in successful development of medication adherence interventions specific to this context also remains unclear. OBJECTIVE To evaluate the existing evidence on the salience of a therapeutic alliance in effective interventions to improve medication adherence in Black patients with diabetes, hypertension, or kidney disease. DATA SOURCES Medline (via PubMed), EMBASE (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL) (EBSCOhost), and PsycINFO (ProQuest) databases. REVIEW METHODS Only randomized clinical trials and pre/post intervention studies published in English between 2009 and 2022 with a proportion of Black patients greater than 25% were included. Narrative synthesis was done. RESULTS Eleven intervention studies met the study criteria and eight of those studies had all-Black samples. Medication adherence outcome measures were heterogenous. Five out of six studies which effectively improved medication adherence, incorporated therapeutic alliance. Seven studies informed by behavioral theories led to significant improvement in medication adherence. DISCUSSION/CONCLUSION Study findings suggest that therapeutic alliance-based interventions are effective in improving medication adherence in Black patients with diabetes and hypertension. Further research to test the efficacy of therapeutic alliance-based interventions to improve medication adherence in Black patients should ideally incorporate cultural adaptation, theoretical framework, face-to-face delivery mode, and convenient locations.
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Affiliation(s)
- Russom Desta
- Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Charlotte Blumrosen
- Department of Medicine and Pediatrics, University of Rochester Medical Center, New York, NY, USA
| | | | - Aades Saluja
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marino A Bruce
- Department of Behavioral and Social Sciences, University of Houston, Tilman J. Fertitta Family College of Medicine, Houston, TX, USA
| | - Tom A Elasy
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Derek M Griffith
- Department of Health Management & Policy, School of Health, Georgetown University, Washington, DC, USA
- Center for Men’s Health Equity, Racial Justice Institute, Georgetown University, Washington, DC, USA
| | - Keith C Norris
- Division of General Internal Medicine & Health Services Research, UCLA, Los Angeles, CA, USA
| | - Kerri L Cavanaugh
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ebele M Umeukeje
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
- Correspondence: Ebele M Umeukeje, Division of Nephrology, Vanderbilt University Medical Center, 1161 21 Avenue MCN S-3223, Nashville, TN, USA, Tel +1 615 936-3283, Fax +1 615 875-5626, Email
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Husted KLS, Dandanell S, Petersen J, Dela F, Helge JW. The effectiveness of body age-based intervention in workplace health promotion: Results of a cohort study on 9851 Danish employees. PLoS One 2020; 15:e0239337. [PMID: 32941507 PMCID: PMC7498070 DOI: 10.1371/journal.pone.0239337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/03/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction The aging population emphasize the need for effective health promotion interventions. The workplace is a prioritized setting for health promotion to reach widely within a population. Body age can be used as a health-risk estimate and as a motivational tool to change health behavior. In this study we investigate body age-based intervention including motivational interview and its effect on health, when applied to real life workplace health promotion. Material and methods Body age-based intervention was performed in 90 companies on 9851 Danish employees from 2011–2017. Metabolic risk factors were assessed, body age score was determined and an individualized motivational interview was conducted at baseline and follow-up. Change in body age score, single risk factors, smoking habits and metabolic syndrome were analyzed. The body age score is a composite score comprising 11 weighted variables. A body age score ≤ 0 is preferred, as this elicit a younger/healthier or equal body age compared to chronological age. Results At 1.3 year follow-up the unhealthiest employees were less likely to participate. Within follow-up participants (39%, n = 3843) body age had improved by a decline in mean body age score of -0.6 and -0.7 years for men and women, respectively (p<0.001). Number of employees with metabolic syndrome had decreased from 646 at baseline to 557 at follow-up (p = 0.005) and 42% of smokers had quit smoking (p<0.001). Conclusion On the basis of this study, we suggest that body age assessment motivates to participate in workplace health promotion, affect high risk behavior such as smoking thus have potential in public health promotion.
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Affiliation(s)
- Karina L. S. Husted
- Department of Biomedical Sciences, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Department of Physiotherapy and Occupational Therapy, University College Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Sune Dandanell
- Department of Biomedical Sciences, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Janne Petersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Flemming Dela
- Department of Biomedical Sciences, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Department of Geriatrics, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jørn W. Helge
- Department of Biomedical Sciences, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Blumrosen C, Desta R, Cavanaugh KL, Laferriere HE, Bruce MA, Norris KC, Griffith DM, Umeukeje EM. Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review. Patient Prefer Adherence 2020; 14:1435-1444. [PMID: 32884245 PMCID: PMC7443008 DOI: 10.2147/ppa.s260684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the US, Blacks with end-stage kidney disease (ESKD) have a four-fold higher prevalence rate of hemodialysis treatment and higher subsequent rates of hemodialysis treatment nonadherence and hospitalization compared to their White peers. Nonadherence to prescribed dialysis therapy is an underestimated life-threatening behavior, because of its association with increased morbidity and mortality. Few studies have specified and systematically evaluated targeted methods of increasing hemodialysis treatment adherence among Black hemodialysis patients with added focus on therapeutic alliance, a rewarding patient-centered relationship between patients and providers, based on common goals and objectives. This review seeks to evaluate the state of the science to determine the salience of a therapeutic alliance for the development of effective interventions positively impacting hemodialysis treatment adherence among Black patients. METHODS Medline (via PubMed), Embase (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL; EBSCOhost), and PsycInfo (ProQuest) databases were used to search for abstracts with the keywords "dialysis", "therapeutic alliance", and "treatment adherence and compliance", including all underlying index terms and alternative variations of terms, in order to cover the entire scope of the field. Only randomized clinical trials and pre/postintervention studies published in the previous 10 years (2009-2019) and including a proportion of Black patients >25% were included for review. RESULTS Only three intervention studies met these criteria, for a total aggregated sample of 130 - mean age 58.1 years and 53% female. None of these studies was composed exclusively of Black patients (range 62%-91.3%), nor did they present data specifically for Blacks. Despite the lack of robust data informing strategies to improve hemodialysis adherence among Blacks with ESRD, a limited number of intervention studies have reported positive effects on hemodialysis attendance. DISCUSSION/CONCLUSION Further research is warranted to fill this significant gap in our understanding of theoretically based, therapeutic alliance-enhanced, and culturally tailored hemodialysis treatment-adherence interventions among Blacks.
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Affiliation(s)
| | | | - Kerri L Cavanaugh
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heather E Laferriere
- Eskind Biomedical Library, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marino A Bruce
- Department of Population Health Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USA
| | - Derek M Griffith
- Center for Research on Men’s Health, Vanderbilt University, Nashville, TN, USA
| | - Ebele M Umeukeje
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
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Salin K, Kankaanpää A, Hirvensalo M, Lounassalo I, Yang X, Magnussen CG, Hutri-Kähönen N, Rovio S, Viikari J, Raitakari OT, Tammelin TH. Smoking and Physical Activity Trajectories from Childhood to Midlife. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E974. [PMID: 30889897 PMCID: PMC6466084 DOI: 10.3390/ijerph16060974] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 02/04/2023]
Abstract
Introduction: Despite substantial interest in the development of health behaviors, there is limited research that has examined the longitudinal relationship between physical activity (PA) and smoking trajectories from youth to adulthood in a Finnish population. This study aimed to identify trajectories of smoking and PA for males and females, and study the relationship between these trajectories from youth to adulthood. Methods: Latent profile analysis (LPA) was used to identify trajectories of smoking and PA separately for males and females among 3355 Finnish adults (52.1% females). Participants' smoking and PA were assessed five to eight times over a 31-year period (3⁻18 years old at the baseline, 34⁻49 years at last follow-up). Multinomial logistic regression analysis was used to study the relationship between the trajectories of smoking and PA. Results: Five smoking trajectories and four to five PA trajectories were identified for males and females. Of the PA trajectory groups, the persistently active group were least likely to follow the trajectories of regular smoking and the inactive and low active groups were least likely to follow non-smoking trajectory group. Likewise, inactive (women only) and low active groups were less likely to belong to the non-smokers group. Conclusions: The study suggests that those who are persistently active or increasingly active have substantially reduced probabilities of being in the highest-risk smoking categories.
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Affiliation(s)
- Kasper Salin
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland.
| | - Anna Kankaanpää
- LIKES Research Centre for Physical Activity and Health, 40014 Jyväskylä, Finland.
| | - Mirja Hirvensalo
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland.
| | - Irinja Lounassalo
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland.
| | - Xiaolin Yang
- LIKES Research Centre for Physical Activity and Health, 40014 Jyväskylä, Finland.
| | - Costan G Magnussen
- Department of Medicine and Division of Medicine, University of Turku and Turku University Hospital, 20500 Turku, Finland.
- Menzies Institute for Medical Research, University of Tasmania, 7005 Hobart, Australia.
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere and Tampere University Hospital, 33100 Tampere, Finland.
| | - Suvi Rovio
- Department of Medicine and Division of Medicine, University of Turku and Turku University Hospital, 20500 Turku, Finland.
| | - Jorma Viikari
- Department of Medicine and Division of Medicine, University of Turku and Turku University Hospital, 20500 Turku, Finland.
| | - Olli T Raitakari
- Department of Medicine and Division of Medicine, University of Turku and Turku University Hospital, 20500 Turku, Finland.
| | - Tuija H Tammelin
- LIKES Research Centre for Physical Activity and Health, 40014 Jyväskylä, Finland.
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Allegrante JP. Advancing the Science of Behavioral Self-Management of Chronic Disease: The Arc of a Research Trajectory. HEALTH EDUCATION & BEHAVIOR 2017; 45:6-13. [PMID: 29258348 DOI: 10.1177/1090198117749010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes advances in the behavioral self-management of chronic disease from the perspective of a 25-year trajectory of National Institute of Health-funded research in arthritis and cardiopulmonary diseases that has sought to develop a transdisciplinary understanding of how applied behavioral science can be used to improve health behaviors, functional status, and health outcomes. The article traces the arc of a novel research program-conducted in collaboration with physician-scientists at Columbia, Weill Cornell Medical College, and New York University School of Medicine-that runs through social cognitive theory, behavioral economics, and the emerging science of positive psychology in an effort to develop promising new approaches to fostering the adoption and maintenance of health-related behavioral change. The article concludes with what has been learned and what the implications of the work are for advancing behavioral self-management and patient education to improve patient outcomes and achieve the compression of morbidity.
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Affiliation(s)
- John P Allegrante
- 1 Teachers College and the Mailman School of Public Health, Columbia University, New York, NY, USA
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Ufholz KE, Harlow LL. Modeling multiple health behaviors and general health. Prev Med 2017; 105:127-134. [PMID: 28893595 DOI: 10.1016/j.ypmed.2017.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 07/12/2017] [Accepted: 08/02/2017] [Indexed: 11/29/2022]
Abstract
Multiple Health Behavior Change assumes health behaviors are related to one another, although research evidence is mixed. More research is needed to understand which behaviors are most closely related and how they collectively predict health. Principle component analysis and structural equation modeling were used to establish a model showing relations between health behaviors, including fruit/vegetable consumption, aerobic and strength exercise, alcohol intake, and smoking, and how these behaviors relate to general physical and mental health functioning in a large, national sample. Although health behaviors were found to coalesce into a health-promoting factor of diet, and exercise, a better overall model fit was found when all behaviors were modeled as separate independent variables. Results suggest that health behaviors relate to one another in complex ways, with perceived health status serving as a mediating variable between specific health behaviors and a factor of physical and mental health. Future research should further investigate how other health behaviors relate to perceptions and overall health, especially among subpopulations.
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Affiliation(s)
| | - Lisa L Harlow
- Department of Psychology, University of Rhode Island, United States
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JaKa MM, Seburg EM, French SA, Wolfson J, Jeffery RW, Levy RL, Langer SL, Sherwood NE. Parent Choice in a Pediatric Obesity Prevention Intervention. HEALTH BEHAVIOR AND POLICY REVIEW 2017; 4:357-366. [PMID: 30680291 PMCID: PMC6342286 DOI: 10.14485/hbpr.4.4.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is value in having parents choose which behaviors to address in obesity interventions, but it is unknown whether they choose behaviors that will effectively impact healthy growth. This study assessed whether child behaviors or parent intention to change behaviors were associated with behaviors parents chose to discuss. METHODS Parent intention to change specific behaviors and time spent discussing behaviors was coded during intervention sessions. RESULTS Child activity, screen-time, energy intake, breakfast, and family meals were associated with time spent discussing these behaviors. Fewer associations were seen between parent intention and time spent discussing these behaviors. CONCLUSIONS Results suggest that in interventions allow choice, parents may choose to discuss the weight-related behaviors their children need to address.
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Affiliation(s)
| | | | - Simone A French
- Division of Epidemiology & Community Health, University of Minnesota
| | | | - Robert W Jeffery
- Division of Epidemiology & Community Health, University of Minnesota
| | - Rona L Levy
- School of Social Work, University of Washington
| | - Shelby L Langer
- Center for Health Promotion & Disease Prevention, Arizona State University
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Swoboda CM, Miller CK, Wills CE. Setting Single or Multiple Goals for Diet and Physical Activity Behaviors Improves Cardiovascular Disease Risk Factors in Adults With Type 2 Diabetes. DIABETES EDUCATOR 2016; 42:429-43. [DOI: 10.1177/0145721716650043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Purpose The purpose of this study was to evaluate a 4-month telephone-based goal-setting and decision support intervention among adults with type 2 diabetes mellitus (T2DM) and multiple risk factors for cardiovascular disease (CVD). Methods A randomized pretest-posttest control group design was employed. Overweight or obese adults aged 40 to 75 years with T2DM and ≥1 additional CVD risk factor were provided with individualized CVD risk information. At baseline and each biweekly telephone call, the multiple-goal group self-selected both diet- and physical activity–related goals, the single goal group set a single goal, and the control group received information about community health resources. Dietary intake was assessed via a food frequency questionnaire, physical activity via questionnaire, and A1C and blood lipids via fasting fingerstick sample. Between-group differences for clinical (ie, A1C, blood pressure, and blood lipids), physical activity, and dietary variables were evaluated using Kruskal-Wallis, Mann-Whitney U, analysis of variance, and t tests. Results From pre- to postintervention, the single-goal group demonstrated significant improvement in systolic blood pressure and intake of servings of fruits, vegetables, and refined grains (all P < .05). The multiple-goal group reported significant reduction in percent energy from total, saturated, monounsaturated, and trans fat intake and significant increase in leisure time walking (all P < .05). Conclusion A multiple-goal approach over 4 months can improve dietary and physical activity outcomes, while a single-goal approach may facilitate improvement in one behavioral domain. Additional research is needed to evaluate maintenance of the achieved changes.
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Affiliation(s)
- Christine M. Swoboda
- Department of Human Sciences, Human Nutrition, Ohio State University, OH (Ms Swoboda, Dr Miller)
- College of Nursing, Ohio State University, OH (Dr Wills)
| | - Carla K. Miller
- Department of Human Sciences, Human Nutrition, Ohio State University, OH (Ms Swoboda, Dr Miller)
- College of Nursing, Ohio State University, OH (Dr Wills)
| | - Celia E. Wills
- Department of Human Sciences, Human Nutrition, Ohio State University, OH (Ms Swoboda, Dr Miller)
- College of Nursing, Ohio State University, OH (Dr Wills)
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Huang JJ, Lin HS, Yen M, Kan WM, Lee BO, Chen CH. Effects of a Workplace Multiple Cardiovascular Disease Risks Reduction Program. Asian Nurs Res (Korean Soc Nurs Sci) 2013; 7:74-82. [DOI: 10.1016/j.anr.2013.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 02/17/2013] [Accepted: 03/20/2013] [Indexed: 11/25/2022] Open
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Koshy P, Mackenzie M, Leslie W, Lean M, Hankey C. Eating the elephant whole or in slices: views of participants in a smoking cessation intervention trial on multiple behaviour changes as sequential or concurrent tasks. BMC Public Health 2012; 12:500. [PMID: 22759785 PMCID: PMC3416689 DOI: 10.1186/1471-2458-12-500] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 07/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper explores smoking cessation participants' perceptions of attempting weight management alongside smoking cessation within the context of a health improvement intervention implemented in Glasgow, Scotland. METHODS One hundred and thirty-eight participants were recruited from smoking cessation classes in areas of multiple deprivation in Glasgow and randomised to intervention, receiving dietary advice, or to control groups. The primary outcome of the study was to determine the % change in body weight. Semi-structured interviews were conducted with a purposive sample of 15 intervention and 15 control participants at weeks 6 (during the intervention) and 24 (at the end of the intervention). The current paper, though predominantly qualitative, links perceptions of behaviour modification to % weight change and cessation rates at week 24 thereby enabling a better understanding of the mediators influencing multiple behaviour change. RESULTS Our findings suggest that participants who perceive separate behaviour changes as part of a broader approach to a healthier lifestyle, and hence attempt behaviour changes concurrently, may be at comparative advantage in positively achieving dual outcomes. CONCLUSIONS These findings highlight the need to assess participants' preference for attempting multiple behaviour changes sequentially or simultaneously in addition to assessing their readiness to change. Further testing of this hypothesis is warranted. TRIAL REGISTRATION ISRCTN94961361.
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Affiliation(s)
- Preethi Koshy
- Human Nutrition, School of Medicine, University of Glasgow, Glasgow, G4 0SF, UK.
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Dean E, Lomi C, Bruno S, Awad H, O'Donoghue G. Addressing the common pathway underlying hypertension and diabetes in people who are obese by maximizing health: the ultimate knowledge translation gap. Int J Hypertens 2011; 2011:835805. [PMID: 21423684 PMCID: PMC3057046 DOI: 10.4061/2011/835805] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 01/11/2011] [Indexed: 01/22/2023] Open
Abstract
In accordance with the WHO definition of health, this article examines the alarming discord between the epidemiology of hypertension, type 2 diabetes mellitus (T2DM), and obesity and the low profile of noninvasive (nondrug) compared with invasive (drug) interventions with respect to their prevention, reversal and management. Herein lies the ultimate knowledge translation gap and challenge in 21st century health care. Although lifestyle modification has long appeared in guidelines for medically managing these conditions, this evidence-based strategy is seldom implemented as rigorously as drug prescription. Biomedicine focuses largely on reducing signs and symptoms; the effects of the problem rather than the problem. This article highlights the evidence-based rationale supporting prioritizing the underlying causes and contributing factors for hypertension and T2DM, and, in turn, obesity. We argue that a primary focus on maximizing health could eliminate all three conditions, at best, or, at worst, minimize their severity, complications, and medication needs. To enable such knowledge translation and maximizing health outcome, the health care community needs to practice as an integrated team, and address barriers to effecting maximal health in all patients. Addressing the ultimate knowledge translation gap, by aligning the health care paradigm to 21st century needs, would constitute a major advance.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 1Z3
| | - Constantina Lomi
- Department of Physiotherapy, Akmi Metropolitan College, 15125 Athens, Greece
| | - Selma Bruno
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, 59072-970 Natal, RN, Brazil
| | - Hamzeh Awad
- Department of Prevention and Care of Diabetes, Faculty of Medicine, Dresden University of Technology and Ludwig-Maximilian University, 80336 Munich, Germany
| | - Grainne O'Donoghue
- Department of Physiotherapy, School of Public Health, Physiotherapy, and Population Science, University College Dublin, Dublin 4, Ireland
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Dean E. Physical therapy in the 21st century (Part I): toward practice informed by epidemiology and the crisis of lifestyle conditions. Physiother Theory Pract 2010; 25:330-53. [PMID: 19842862 DOI: 10.1080/09593980802668027] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Part I of this two-part introduction to this Special Issue on the practice of physical therapy in the 21st century outlines the epidemiological basis and rationale for evidence-informed physical therapy practice for addressing contemporary health priorities. This evidence emanates from the definition of health by the World Health Organization (WHO) and the International Classification of Functioning (ICF), and WHO and other international databases on the prevalence of lifestyle conditions. Lifestyle conditions include ischemic heart disease, smoking-related conditions, hypertension and stroke, obesity, diabetes, and cancer. Epidemiological data combined with evidence supporting the effectiveness of noninvasive interventions related to physical therapy to address these priorities (e.g., health education and exercise) are highly consistent with the promotion of health and wellness and the ICF. Given their commitment to exploiting effective noninvasive interventions, physical therapists are in a preeminent position to focus on prevention of these disabling and lethal conditions in every client or patient, their cure in some cases, as well as their management. Thus, a compelling argument can be made that clinical competencies in 21st century physical therapy need to include assessment of smoking and smoking cessation (or at least its initiation), basic nutritional assessment and counseling, recommendations for physical activity and exercise, stress assessment and basic stress reduction recommendations, and sleep assessment and basic sleep hygiene recommendations. The physical therapist can then make an informed clinical judgment regarding whether a client or patient needs to be referred to another professional related to one or more of these specialty areas. The prominence of physical therapy as an established health care profession and its unique pattern of practice (prolonged visits over prolonged periods of time) attest further to the fact that physical therapists are uniquely qualified to lead in the assault on lifestyle conditions. Evidence-based physical therapy practiced within the context of epidemiological indicators (i.e., evidence-informed practice) maximally empowers clinicians to promote lifelong health in every person and in turn, the health of communities. This vision of physical therapy's leading role in health promotion and health care in the 21st century holds the promise of reducing the need for invasive health interventions (drugs and surgery). Part II of this introduction describes evidence-based physical therapy practice within this context of evidence-informed practice.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Affiliation(s)
- Alfredo Morabia
- Center for the Biology of Natural Systems, Queens College, CUNY, 163-03 Horace Harding Expressway, Flushing, NY 11365, USA
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Prochaska JJ, Spring B, Nigg CR. Multiple health behavior change research: an introduction and overview. Prev Med 2008; 46:181-8. [PMID: 18319098 PMCID: PMC2288583 DOI: 10.1016/j.ypmed.2008.02.001] [Citation(s) in RCA: 400] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 01/31/2008] [Accepted: 02/01/2008] [Indexed: 11/20/2022]
Abstract
In 2002, the Society of Behavioral Medicine's special interest group on Multiple Health Behavior Change was formed. The group focuses on the interrelationships among health behaviors and interventions designed to promote change in more than one health behavior at a time. Growing evidence suggests the potential for multiple-behavior interventions to have a greater impact on public health than single-behavior interventions. However, there exists surprisingly little understanding of some very basic principles concerning multiple health behavior change (MHBC) research. This paper presents the rationale and need for MHBC research and interventions, briefly reviews the research base, and identifies core conceptual and methodological issues unique to this growing area. The prospects of MHBC for the health of individuals and populations are considerable.
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Affiliation(s)
- Judith J Prochaska
- Department of Psychiatry at the University of California, San Francisco, CA 94143-0984, USA.
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Multiple Health Behavior Research represents the future of preventive medicine. Prev Med 2008; 46:281-5. [PMID: 18319100 DOI: 10.1016/j.ypmed.2008.01.015] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 01/30/2008] [Indexed: 11/20/2022]
Abstract
Given the disease and cost burdens, Multiple Health Behavior Research represents the future of preventive medicine. Growing evidence in this special issue and beyond indicates that simultaneous and sequential interventions can be effective. The challenge for the future is to make such interventions more effective, cost effective and less demanding. Co-variation represents one innovative approach in which effective change on one treated behavior increases the odds of effective action on a second targeted behavior. Co-variation can occur when all behaviors received full treatment, when one receives full treatment and the others receive minimal treatment and when only one behavior is treated and others co-vary without treatment. Integrative treatments represent another innovation in which higher order constructs drive change on multiple behaviors related to the construct and treatment has to be only on one higher order behavior. A more integrated approach to research and practice involves new paradigms complementing established paradigms. Multiple behaviors proactively treated in populations at home or work by computer-based and stage-based interventions designed to generate co-variation that produces greater impacts can complement traditional paradigms that treat single behaviors in individual patients in clinics by clinicians with action-oriented modular interventions designed for specific behaviors to produce significant efficacy. More inclusive research to support more inclusive practices can hopefully lead to more inclusive care.
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