Identifying patient-level factors associated with interest in psychosocial services during cancer: A brief report.

OBJECTIVES: Uptake of psychosocial services during cancer treatment remains relatively low. To use these services efficiently, novel approaches - based on evidence-based theory - are needed to understand cancer patients' readiness to seek psychosocial services. Guided by the transtheoretical model (TTM), we investigated individuals' readiness to use psychosocial services by assessing decisional conflict (pros/cons) and self-efficacy, which are established as the most important constructs of predicting a specific behavior. METHODS: In these secondary analyses, we examined demographic and treatment-related factors in a national sample of adult cancer patients and survivors in the United States as predictors of decisional balance (pros/cons) and self-efficacy (i.e., two core TTM constructs) of engaging in psychosocial services. Participants were recruited through an online survey. In addition to examining demographic factors (age, sex, race, and marital status) as independent variables using t tests and correlations, treatment-related variables, such as having multiple cancers, type of cancer, type of treatment, and treatment setting were included. RESULTS: Four hundred and sixty-six participants completed the survey. The sample was primarily Caucasian (79%) and female (54.7%); average age was 47.9 (SD = 14.8). While no significant relationships emerged for self-efficacy, younger age and non-Caucasian race were significantly related to greater cons of seeking psychosocial care. Finally, those with multiple cancers versus reporting only one malignancy endorsed more cons of seeking psychosocial care. CONCLUSIONS: These data highlight the importance of measuring the cons of seeking psychosocial care during cancer treatment, with younger age, non-Caucasian, and those reporting experience with multiple cancers endorsing greater cons. This may impact eventual uptake of available services. Future research should identify individuals at risk for declining services based on perceived cons of seeking psychosocial care during cancer.

A philosophy of health: life as reality, health as a universal value.

Emphases on biomarkers (e.g. when making diagnoses) and pharmaceutical/drug methods (e.g. when researching/disseminating population level interventions) in primary care evidence philosophies of health (and healthcare) that reduce health to the biological level. However, with chronic diseases being responsible for the majority of all cause deaths and being strongly linked to health behavior and lifestyle; predominantly biological views are becoming increasingly insufficient when discussing this health crisis. A philosophy that integrates biological, behavioral, and social determinants of health could benefit multidisciplinary discussions of healthy publics. This manuscript introduces a Philosophy of Health by presenting its first five principles of health. The philosophy creates parallels among biological immunity, health behavior change, social change by proposing that two general functions-precision and variation-impact population health at biological, behavioral, and social levels. This higher-level of abstraction is used to conclude that integrating functions, rather than separated (biological) structures drive healthy publics. A Philosophy of Health provides a framework that can integrate existing theories, models, concepts, and constructs.

Development and Implementation of a Psychological Service for Patients With Cancer.

Cancer patients frequently experience considerable distress during diagnosis and treatment. The aims of this study were to describe the development and utilization of a psychological service for cancer patients at a community hospital-and to provide preliminary results on clinical outcomes in a "real-world" clinical setting. This program was developed collaboratively by individuals from a university-based clinical psychology doctoral program and a community hospital. The psychological service was comprised of a licensed, PhD-level clinical psychologist and seven clinical psychology doctoral students. Patients were typically referred by their oncologists or nurses. Distress, depression, and anxiety were evaluated for a small subsample of participants. From the time the program was initiated, 238 patients between ages 18 and 95 (M = 66.4) were evaluated over a 3-year period. Most patients (77.8%) were offered psychosocial care. Although 49.8% declined treatment, 23.6% attended one session and 26.6% attended two or more. Average number of individual sessions was 2.77 (SD=8.31, range=0-96) and 0.06 (SD=0.43, range=0-4) for groups sessions. Patients referred through the Survivorship Training and Rehabilitation (STAR) Program® (i.e., a program providing multidisciplinary services) were more likely to engage in psychosocial care than those who found out about behavioral health in other ways. Patients experienced declines in depression (Wilks' Λ=.580, F(2, 14)=5.08, p=.022), but not anxiety (Wilks' Λ=.613, F(2, 12)=3.79, p=.053) across sessions. An in-depth case description is provided. Distress tracking may be improved if nurses, oncologists, and behavioral health providers administer measures. Partnerships between clinical psychology doctoral programs and hospitals may be mutually beneficial - and may advance the dissemination and implementation of evidence-based psychosocial interventions. Hospitals offering cancer treatment may benefit from generating referrals for comprehensive cancer care. These efforts can serve as a model for other hospitals seeking to integrate behavioral health into routine cancer treatment.

Generating psychotherapy breakthroughs: Transtheoretical strategies from population health psychology.

Over the past 40 years, few breakthroughs have dramatically increased the impacts of psychotherapy. There have been new and exciting therapies, but the research does not convincingly demonstrate that any recent or more established therapies produce greater impacts than 40 years ago. Seven strategies from the transtheoretical model that have produced breakthroughs in health psychology/population health are analyzed to illustrate how they can similarly generate breakthroughs in mental health outcomes. The first three strategies can enhance impacts by increasing the percentage of troubled populations entering and completing best-practice treatments: reach, recruit, and retain. The fourth strategy accords higher value to synergy than to specificity by generating more benefits from whole-health therapies that briefly treat the small number of behaviors that account for a large percentage of chronic disabilities and premature deaths. The fifth breakthrough strategy creates multiple synergistic changes within individuals; changing one problem behavior promotes the probabilities that individuals will change a second problem (coaction). The sixth strategy increases impacts by complementing psychologists with tailored technology that extends their influence into homes, schools, workplaces, and communities. The seventh strategy calls on researchers to test their innovations against best practices and to benchmark outcomes, like those found with depression. We conclude by advancing a framework that can generate more inclusive and effective psychotherapies by integrating individual health care with population health practices. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Longitudinal analysis of intervention effects on temptations and stages of change for dietary fat using parallel process latent growth modeling.

The Dietary Guidelines for Americans recommend a 20-35 percent daily intake of fat. Resisting the temptation to eat high-fat foods, in conjunction with stage of readiness to avoid these foods, has been shown to influence healthy behavior change. Data ( N = 6516) from three randomized controlled trials were pooled to examine the relationships among direct intervention effects on temptations and stage of change for limiting high-fat foods. Findings demonstrate separate simultaneous growth processes in which baseline level of temptations, but not the rate of change in temptations, was significantly related to the change in readiness to avoid high-fat foods.

Measures of psychosocial care utilization in a national sample of cancer patients.

OBJECTIVE: Cancer is one of the most physically and emotionally debilitating diseases. Despite evidence that psychosocial care can improve psychological and physiological functioning, as few as 4.4% of patients are willing to engage in psychosocial treatment. Few studies explored drivers of psychosocial care underutilization. Therefore, treatment engagement strategies are needed, by identifying patients' barriers to psychosocial treatment. This study evaluated readiness to utilize psychosocial care by developing transtheoretical model (TTM) measures of stage of change, decisional balance, and self-efficacy. METHOD: Online survey data was collected from a national sample of 475 adults (Mage = 47.89, SD = 14.77) with cancer diagnoses. A sequential process of measure development was used. Semistructured expert and research participant interviews were conducted for initial item development, followed by exploratory, confirmatory, and external validation analyses. RESULTS: Principal components analyses (PCA) indicated two, 4-item factors (pros α = .874; cons α = .716) for decisional balance. Confirmatory factor analyses (CFA) supported a 2-factor correlated model, χ²(19) = 68.56, CFI = .962, RMSEA = .078. For self-efficacy, PCA indicated two, 3-item components (physical α = .892; social/emotional α = .708). CFA supported this structure χ²(8) = 23.72, CFI = .989, RMSEA = .067. Physical component items included fatigue, pain, and discomfort. Multivariate analyses indicated significant cross-stage differences for pros, cons, and self-efficacy. CONCLUSIONS: Findings support the validity of the developed stage of change, 8-item decisional balance, and 6-item self-efficacy measures for psychosocial care. Clinicians could use these tools to address perceived cons of psychosocial care, including shame and self-efficacy (e.g., using psychosocial care despite pain). These scales may help treatment teams better address barriers to psychosocial care utilization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Stages of change and psychotherapy outcomes: A review and meta-analysis.

The transtheoretical model and the stages of change are often used to adapt treatment to the individual client. The aims of this study were to review the stages of change and popular measures of change readiness in psychotherapy and to conduct a meta-analysis of the relation between readiness measures and psychotherapy outcomes. We report data from 76 studies, encompassing 25,917 patients. Moderate-sized effects (d = 0.41) were found for the association among multiple disorders, including substance and alcohol use, eating disorders, and mood disorders. Outcomes were a function of the pretreatment stage of change; that is, the farther a patient along the stages, the better the treatment outcomes. This review added 37 studies to the data reported in 2010, further strengthening the link between readiness and therapy outcomes. The article concludes with limitations of the research, diversity considerations, and therapeutic practices for stage matching in psychotherapy specifically and behavioral health more generally.

Integrated Primary Care Readiness and Behaviors Scale: Development and validation in behavioral health professionals.

INTRODUCTION: Although integrated primary care (IPC) is growing, several barriers remain. Better understanding of behavioral health professionals' (BHPs') readiness for and engagement in IPC behaviors could improve IPC research and training. This study developed measures of IPC behaviors and stage of change. METHOD: The sample included 319 licensed, practicing BHPs with a range of interests and experience with IPC. Sequential measurement development procedures, with split-half cross-validation were conducted. RESULTS: Exploratory principal components analyses (N = 152) and confirmatory factor analyses (N = 167) yielded a 12-item scale with 2 factors: consultation/practice management (CPM) and intervention/knowledge (IK). A higher-order Integrated Primary Care Behavior Scale (IPCBS) model showed good fit to the data, and excellent internal consistencies. The multivariate analysis of variance (MANOVA) on the IPCBS demonstrated significant large-sized differences across stage and behavior groups. DISCUSSION: The IPCBS demonstrated good psychometric properties and external validation, advancing research, education, and training for IPC practice. (PsycINFO Database Record

Development and Preliminary Psychometric Evaluation of Decisional Balance and Self-Efficacy Measures for Managing Anxiety in a National Sample of Clinically Anxious Adults.

PURPOSE: Anxiety is the most common and costly mental illness in the United States. Reducing avoidance is a core element of evidence-based treatments. Past research shows readiness to address avoidance affects outcomes. Investigating avoidance from a transtheoretical model (TTM) perspective could facilitate tailored approaches for individuals with low readiness. This study developed and examined psychometric properties of TTM measures for addressing anxiety-based avoidance. DESIGN: Cross-sectional survey. SETTING: Community centers, online survey. PARTICIPANTS: Five hundred ninety-four individuals aged 18 to 70 with clinically significant anxiety. MEASURES: Overall Anxiety Severity Questionnaire, stages of change, decisional balance, and self-efficacy. ANALYSIS: The sample was randomly split into halves for principal component analyses (PCAs) and confirmatory factor analyses (CFAs) to test measurement models. Further analyses examined relationships between constructs. RESULTS: For decisional balance, PCA indicated two 5-item factors (pros and cons). Confirmatory factor analysis supported a 2-factor correlated model, Satorra-Bentler scaled chi-square [Formula: see text], comparative fit index (CFI = 0.94), root mean square error of approximation (RMSEA = 0.07), pros: α = 0.87, ρ = 0.87, cons: α = 0.75, and ρ = 0.75. For self-efficacy, PCA indicated one 6-item factor supported by CFA, [Formula: see text], P < .01, CFI = 0.98, RMSEA = 0.09, α = 0.90, ρ = 0.87. As hypothesized, significant cross-stage differences were observed for pros and self-efficacy, and significant relationships between anxiety severity and pros, cons, and self-efficacy were found. CONCLUSION: Findings show strong psychometric properties and support the application of a readiness-based model to anxiety. In contrast to findings of other behaviors, cons remain high in action and maintenance. These measures provide a solid empirical foundation to develop TTM-tailored interventions to enhance engagement in treatment.

The Influence of Engagement and Satisfaction on Smoking Cessation Interventions: A Qualitative Study.

BACKGROUND: Tobacco use remains the leading cause of preventable disease and death. Most smokers are not motivated to quit; however, most smoking cessation interventions are designed for smokers who are ready to take action. OBJECTIVES: The aim of the present study was to describe participant engagement and satisfaction with telephonic smoking cessation coaching with a population of smokers at different stages of readiness to quit. METHODS: Qualitative description was used to capture the experiences of 62 individuals who participated in telephonic smoking cessation coaching using semistructured interviews. RESULTS: Results indicate that person-centered communication facilitated engagement and was valued equally or more than perceived coach smoking cessation knowledge. Engagement with the intervention was associated with increased satisfaction, smoking cessation/reduction and perceived convenience of intervention. Conclusions/Importance: Findings indicate that unmotivated smokers can be proactively recruited and engaged in telephonic smoking cessation treatment and that person-centered communication and convenience are important variables that should be considered when implementing health interventions. Telephonic coaching has the potential to reach a large segment of the population with access barriers and could lead to important health behavior change. Intensive provider training that includes person-centered communication strategies is strongly recommended. Specific suggestions for successful implementation and dissemination are provided.

Stages of change in obesity and weight management: factorial structure of the Italian version of the University of Rhode Island Change Assessment Scale.

PURPOSE: To examine the factorial structure of the University of Rhode Island Change Assessment Scale (IT-URICA) for weight management in a sample of Italian overweight and obese patients enrolled in a nutritional rehabilitation program. METHODS: 334 inpatients completed the translated and adjusted version of the IT-URICA at admission to the hospital. Psychometric testing included confirmatory factor analysis and internal consistency (Cronbach's α). RESULTS: The IT-URICA for weight management was successfully translated into Italian, and the factorial analysis confirmed the four-factor solution of the commonly accepted version of the measure. CONCLUSION: High levels of RTC are considered critical to the long-term success of weight management, and the IT-URICA may be an appropriate measure of motivational readiness for use among Italian overweight and obese patients. Its use is, therefore, recommended for clinical and research purposes.

Baseline Predictors of Singular Action Among Participants With Multiple Health Behavior Risks.

PURPOSE: Previous studies found that treatment effects can change two behaviors, but not one. This study examined baseline transtheoretical model constructs as three alternative predictors (stage of change, effort, and severity) of singular action among participants with co-occurring health behavior risks. DESIGN: The study examined participants at risk for three pairs of behaviors (sun and smoking; smoking and diet; and diet and sun). Analyses were conducted with participants who changed only one behavior in a pair (singular action). SETTING: School and home-based behavior change programs recruited participants via schools, worksites, and physician practices. School, worksite, medical, and home-based prevention programs were the study setting. SUBJECTS: The sample (N = 3213) was age 44.6 years (SD, 11.1 years), 94.6% white, and 63.7% female. MEASURES: Stages of change, effort, and severity variables were measured. ANALYSIS: Pooled data were analyzed using logistic regressions from three randomized controlled trials. RESULTS: Across all three behaviors, stage of change, effort, and severity effects were consistently related to behavior change at 24 months. Change efforts on one behavior were related to change on another behavior. Baseline sun severity (odds ratio, .97 [.94, 1.00]; p = .046) and smoking severity (odds ratio, .89 [.80, .98]; p = .019) were significant predictors of change on diet at final follow-up. CONCLUSION: Stage of change was the biggest predictor. Problem severity was the smallest predictor of change at 2-year follow-up. Four of six predictors were within behaviors, whereas two were between.

Extending Theory-Based Quantitative Predictions to New Health Behaviors.

BACKGROUND: Traditional null hypothesis significance testing suffers many limitations and is poorly adapted to theory testing. PURPOSE: A proposed alternative approach, called Testing Theory-based Quantitative Predictions, uses effect size estimates and confidence intervals to directly test predictions based on theory. METHOD: This paper replicates findings from previous smoking studies and extends the approach to diet and sun protection behaviors using baseline data from a Transtheoretical Model behavioral intervention (N = 5407). Effect size predictions were developed using two methods: (1) applying refined effect size estimates from previous smoking research or (2) using predictions developed by an expert panel. RESULTS: Thirteen of 15 predictions were confirmed for smoking. For diet, 7 of 14 predictions were confirmed using smoking predictions and 6 of 16 using expert panel predictions. For sun protection, 3 of 11 predictions were confirmed using smoking predictions and 5 of 19 using expert panel predictions. CONCLUSION: Expert panel predictions and smoking-based predictions poorly predicted effect sizes for diet and sun protection constructs. Future studies should aim to use previous empirical data to generate predictions whenever possible. The best results occur when there have been several iterations of predictions for a behavior, such as with smoking, demonstrating that expected values begin to converge on the population effect size. Overall, the study supports necessity in strengthening and revising theory with empirical data.

Transtheoretical Model Constructs' Longitudinal Prediction of Sun Protection Over 24 Months.

PURPOSE: This research examined dynamic transtheoretical model (TTM) constructs for adopting sun protection practices. This secondary data analysis pooled four large population-based TTM-tailored intervention studies and examined use of constructs across three groups, organized by longitudinal progress: maintainers, relapsers, and stable non-changers. METHODS: A total of 3463 adults, in the USA, who met criteria for unsafe sun exposure at baseline received a TTM-tailored computerized intervention at baseline, 6 months, and 12 months. The final analytic sample consisted of 1894 participants; the majority were female, White, married, and middle-aged. The three groups were assessed with reliable and valid scales assessing use of TTM constructs at baseline, 6 months, 12 months, and 24 months. Analyses included a MANOVA followed by a series of ANOVAs, with Tukey follow-up tests assessing differences in use of TTM constructs across the three groups at each timepoint. RESULTS: Findings demonstrated that relapsers and maintainers were similar in their use of most TTM processes of change at baseline, with the exception of Consciousness Raising, Stimulus Control, Reinforcement Management, and Self-Liberation. CONCLUSIONS: These findings suggest that although relapsers reverted to unsafe sun practices, their overall greater use of processes of change indicates that their change efforts remain better than that of stable non-changers.

Motivation for HPV Vaccination Among Young Adult Men: Validation of TTM Decisional Balance and Self-Efficacy Constructs.

PURPOSE: In the United States, 36% of human papillomavirus (HPV)-related cancers occur among men. HPV vaccination can substantially reduce the risk of HPV infection; however, the vast majority of men are unvaccinated. This study developed and validated transtheoretical model-based measures for HPV vaccination in young adult men. DESIGN: Cross-sectional measurement development. SETTING: Online survey of young adult men. SUBJECTS: Three hundred twenty-nine mostly college-attending men, ages 18 to 26. MEASURES: Stage of change, decisional balance (pros/cons), and self-efficacy. ANALYSIS: The sample was randomly split into halves for exploratory principal components analysis (PCA), followed by confirmatory factor analyses (CFA) to test measurement models. Multivariate analyses examined relationships between scales. RESULTS: For decisional balance, PCA revealed two uncorrelated five-item factors (pros α = .78; cons α = .83). For the self-efficacy scale, PCA revealed a single-factor solution (α = .83). CFA confirmed that the two-factor uncorrelated model for decisional balance and a single-factor model for self-efficacy. Follow-up analyses of variance supported the theoretically predicted relationships between stage of change, pros, and self-efficacy. CONCLUSION: This study resulted in reliable and valid measures of pros and self-efficacy for HPV vaccination that can be used in future clinical research.

Fat Reduction Efforts: A 24-Month Longitudinal Comparison of a Large Sample of Maintainers, Relapsers, and Non-Changers.

This research examined dynamic transtheoretical model (TTM) constructs for dietary fat reduction. This secondary data analysis pooled three large population-based TTM-tailored school, worksite, medical, and home-based intervention studies and examined use of constructs across three groups organized by longitudinal progress (dynatypes): Maintainers, Relapsers, and Stable Non-Changers. The criteria for successful change, at the time, were that less than 30% of calories came from fat. A total of 2,718 adults met criteria for an unhealthy diet at baseline. The majority of participants were female, White, married, and middle-aged. Demographics, Stage of Change, Processes of Change, Decisional Balance, and Temptations were measured. Dynatype groups were assessed with reliable and valid scales assessing constructs at baseline and 6, 12, and 24 months. Analyses included a multivariate analysis of variance followed by a series of analyses of variance, with Tukey follow-up tests assessing differences in use of TTM constructs across the three groups at each time point. Relapsers and Maintainers were similar in their use of all TTM Processes of Change at baseline, with the exception of Self-Liberation (η(2) = 0.15, p < .001) and Reinforcement Management (η(2) = 0.01, p < .001). Although Relapsers reverted to an unhealthy diet, their overall greater use of Processes of Change suggests that their behaviors and strategy use remain better than that of the Stable Non-Changer group. Results suggest that specific cognitive and behavioral constructs may contribute differentially to intervention outcomes.

Sustainable transportation stage of change, decisional balance, and self-efficacy scale development and validation in two university samples.

Single occupancy vehicle (SOV) transportation is a key contributor to climate change and air pollution. Sustainable transportation (ST), commuting by any means other than SOV, could both slow climate change and enhance public health. The transtheoretical model (TTM) provides a useful framework for examining how people progress towards adopting ST. Short valid and reliable measures for ST decisional balance, self-efficacy, and climate change doubt were developed and their relationship with stages of change was examined. Two large university-based volunteer samples participated in measurement studies. Using multiple procedures, three brief internally consistent measures were developed: decisional balance, self-efficacy, and climate change doubt. The stages of change correctly discriminated both decisional balance and self-efficacy, as well as replicated hypothesized relationships. Climate change doubt did not vary by stages; however, it may prove useful in future studies. Results support the validation of these measures and the application of the TTM to ST.

Transtheoretical Principles and Processes for Adopting Physical Activity: A Longitudinal 24-Month Comparison of Maintainers, Relapsers, and Nonchangers.

This study examined longitudinal differences in use of transtheoretical model (TTM) behavior change constructs in maintainers (who reached and maintained exercise guidelines), relapsers (who reached guidelines, then regressed), and nonchangers (who did not reach guidelines). Data from two population-based TTM-tailored randomized trial intervention groups targeting exercise behavior (N = 1050) were pooled, and analyses assessed differences in TTM constructs between the three groups at baseline, 12 months, and 24 months. Findings indicated that relapsers tended to use TTM variables similarly to maintainers with the exception of self-efficacy, consciousness raising, and most behavioral processes of change, at 24 months. Nonchangers, however, used all TTM variables less than maintainers at nearly every time point. Findings suggest that relapsers remain more active than nonchangers in terms of use of change processes. Poor response to interventions (nonchangers) may be predicted by low baseline engagement in change processes. Although relapsers reverted to physical inactivity, their overall greater use of TTM constructs suggests that their efforts to change remain better than those of the stable nonchanger group. Future research can focus on treatment engagement strategies to help the stable nonchangers initiate change and to help relapsers to maintain treatment gains.

The Functional Well-Being Scale: a measure of functioning loss due to well-being-related barriers.

The objective of this study was to develop the Pro-Change Functional Well-Being Scale, a measure that provides an informative evaluation of general functioning loss due to well-being-related barriers. Exploratory and confirmatory analyses on data from 642 individuals supported a one-factor solution with good model fit. A strong positive correlation existed between the Pro-Change Functional Well-Being Scale and Well-Being Assessment for Productivity. Initial construct validity was demonstrated by predictable relationships between functioning loss and other measures of health and well-being. This initial psychometric evidence suggests that the Pro-Change Functional Well-Being Scale is a reliable and valid assessment of functioning loss due to common well-being-related barriers.

Co-occurrence and coaction of stress management with other health risk behaviors.

This study provides a preliminary investigation of the role of stress management in multiple behavior change. Risk status on stress management and five health behaviors (healthy eating, exercise, alcohol, smoking, and depression management) was assessed before and after a multiple behavior change intervention. Findings suggested a link between stress management and a worse health risk behavior profile at baseline. Results also showed relationships between improved stress management over 6 months and heightened odds of improving on specific behaviors as well as improving one's overall behavioral risk profile. Particularly strong links between stress management and energy balance and other affective behaviors were observed.