Effectively implementing healthy and sustainable food practices in out-of-home food service locations: The perspective of the catering staff members.

Restaurants, canteens, residential care, hospitals and other out-of-home food service locations can play an important role in improving people's diet quality by offering healthier and more sustainable food choices. However, the effectiveness of implementing sustainable and healthy food practices at these locations is, at least partly, dependent on the extent to which they are accepted and implemented by the staff members. This study aims to assess staff members' motivation, perceived capability, perceived opportunity and their readiness to change their behaviour (i.e., stages of change) in offering more healthy and sustainable food options to their customers or patients. Eleven out-of-home locations that wanted to adjust their assortment towards more healthy and sustainable product offerings participated in this study and were able to distribute a comparable questionnaire among their staff members to assess their perceived readiness to change. Results among 268 participants show that staff members find both a healthy and sustainable food assortment important and also seem to be motivated to improve their food assortment regarding health and sustainability. Perceived opportunity seems to be the largest barrier for staff members, although there is also room for improvement regarding their perceived capability. In addition, personal motivation seems to play the dominant role in staff members' readiness to change the health of the assortment, whereas perceived capability seems to play the dominant role in their perceived readiness to change the sustainability of the assortment. This study shows that taking into account the perspective of the catering staff members may help to effectively implement healthy and sustainable food practices in out-of-home food service locations.

Gradual behaviour change towards meat reduction revisited: Applying the decisional balance scale in a Dutch study.

Meat moderation is needed to mitigate climate change and to address issues related to animal welfare and public health. Yet little is known on the process that consumers go through towards meat-reduced diets. Strässner and Hartmann (2023) recently developed the decisional balance scale (DB scale) for meat reduction, in order to get a better understanding of the trade-offs that consumers encounter in this dietary shift. The current study sets out to replicate their German study in the Dutch context. A survey has been conducted among a representative sample of Dutch adults (N=1,982). Overall, the present study corroborated Strässner and Hartmann's findings. Similar to the German situation, Legitimation is the most important barrier and the Downsides of factory farming is the most important motivator for meat reduction in the Netherlands. The present study extends the German study by comparing the DB scale with other established scales in research on meat reduction. Although several motivational elements related to the legitimacy of eating meat, health impact and production of meat appear in different instruments, the DB scale sets itself apart in adding practical elements (feasibility). Finally, the insights in the decision balance of population subgroups at different stages of behaviour change (no intention, intention, performing) showed that the further in the meat reduction process, the more the pros outweigh the cons. With this, the current study provides valuable insights in bolstering consumers in meat moderation. Our findings support the idea of a gradual shift, and reveal that there is potential for acceleration in behaviour change towards meat reduction to be found in adjusting the self-evidence of high-intensity livestock farming systems and the meat-centric food consumption culture.

An integrated theory based-educational intervention to change intention to have a child: study protocol of a cluster randomized controlled trial.

BACKGROUND: In high- and low-income countries, declining birth rates have become a global concern. Couples do not have enough information about the complications of delaying and reducing childbearing and this leads them to make inappropriate decisions. Therefore, this study aims to evaluate whether an educational program based on integrating the Theory of Planned Behavior (TPB) and the Trans-Theoretical Model (TTM) affects child-free couples' intention to have children and minimizes the consequences of this decline. METHODS: Thirty couples (intervention, n = 15; control, n = 15) will be enrolled in this cluster randomized controlled trial. After collecting baseline data and separating participants in the pre-contemplation and contemplation stages based on the TTM, the samples were randomly assigned to the intervention and control groups. The intervention group will receive 60-min training based on TPB components for 4 weeks. The first follow-up assessment was performed immediately after the intervention and the final assessment 6 months later. For all 3 time assessments, three questionnaires will be used: The knowledge questionnaire, the TTM, and the TPB questionnaire. The most important consequences are changes in knowledge, attitudes, subjective norms, perceived behavioral control, and stages of intentions to have children. DISCUSSION: Decision-makers will use the results of this study as a basis to design appropriate, transparent, and useful policies and interventions to improve or stop the decline of the fertility rate at the national level. Also, this study will help young couples who wish to have a child in their lifetime by providing relevant information so that they do not miss this opportunity and face the consequences of delaying having a child. Trial registration This study was approved by the Iranian Registry of Clinical Trials (IRCT), Number: IRCT20220618055210N2, Date of registration: 2023-10-03.

Implementation of continuous-wave Doppler ultrasound to detect the high-risk foetus in the low-risk mother: lessons from South Africa.

INTRODUCTION: Detecting the risk of stillbirth during pregnancy remains a challenge. Continuous-wave Doppler ultrasound (CWDU) can be used to screen for placental insufficiency, which is a major cause of stillbirths in low-risk pregnant women. This paper describes the adaptation and implementation of screening with CWDU and shares critical lessons for further rollout. Screening of 7088 low-risk pregnant women with Umbiflow™ (a CWDU device) was conducted in 19 antenatal care clinics at nine study sites in South Africa. Each site comprised a catchment area with a regional referral hospital and primary healthcare antenatal clinics. Women with suspected placental insufficiency as detected by CWDU were referred for follow-up at the hospital. A 35-43% reduction in stillbirths was recorded. METHODS: The authors followed an iterative reflection process using the field and meeting notes to arrive at an interpretation of the important lessons for future implementation of new devices in resource-constrained settings. RESULTS: Key features of the implementation of CWDU screening in pregnancy combined with high-risk follow-up are described according to a six-stage change framework: create awareness; commit to implement; prepare to implement; implement; integrate into routine practice; and sustain practice. Differences and similarities in implementation between the different study sites are explored. Important lessons include stakeholder involvement and communication and identifying what would be needed to integrate screening with CWDU into routine antenatal care. A flexible implementation model with four components is proposed for the further rollout of CWDU screening. CONCLUSIONS: This study demonstrated that the integration of CWDU screening into routine antenatal care, combined with standard treatment protocols at a higher-level referral hospital, can be achieved with the necessary resources and available maternal and neonatal facilities. Lessons from this study could contribute to future scale-up efforts and help to inform decisions on improving antenatal care and pregnancy outcomes in low- and middle-income countries.

Motivational readiness for physical activity and health literacy: results of a cross-sectional survey of the adult population in Germany.

BACKGROUND: Health literacy, defined as the knowledge, motivation, and competences to use health information to improve health and well-being, is associated with regular physical activity. However, there is limited evidence on whether health literacy is also related to the motivational readiness for physical activity in a general population. The aim of this study was to investigate whether motivational readiness for leisure-time physical activity is associated with health literacy. METHODS: Analyses were based on data of 21,895 adults from the cross-sectional German Health Update and European Health Interview Survey 2014/2015 (GEDA 2014/2015-EHIS). Motivational readiness for leisure-time physical activity was assessed with stages of change for physical activity with a set of validated items. It was then classified, according to an established algorithm, into five stages: precontemplation, contemplation, preparation, action, and maintenance. Health literacy was measured with the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and categorised as low, medium, and high. For bivariate and multinomial logistic regression analyses, the stages were categorised in three phases as: (1) no intention (precontemplation), (2) planning (contemplation or preparation), and (3) in activity (action or maintenance). The models were adjusted for sex, age, education, health consciousness, self-efficacy, and self-perceived general health status. RESULTS: High compared to low health literacy was associated with a 1.65-times (95% CI = 1.39-1.96) greater probability of being in activity than planning. High compared to low health literacy was associated with a reduced risk of having no intention to change physical activity behaviour (relative risk ratio, RRR = 0.84, 95% CI = 0.75-0.95). The associations persisted after adjusting for covariates. CONCLUSION: High health literacy was positively associated with more advanced phases of motivational readiness for leisure-time physical activity. Therefore, taking health literacy into account in interventions to promote motivational readiness for leisure-time physical activity could be a useful approach.

Gradual behaviour change towards meat reduction: Development and validation of a novel decisional balance scale.

Meat reduction is gaining attention among consumers, marketers, policymakers and scientists. Yet little is known about decision-making processes and behaviour change towards meat reduction. This paper explores the applicability of the decisional balance (DB) framework to the field of meat reduction. A novel DB scale to measure the perceived importance of beliefs about meat reduction at different stages of behaviour change was developed and validated in two studies with German meat eaters. In Study 1 (N = 309), the item inventory was tested using an exploratory factor analysis and then validated in Study 2 (N = 809). The results yielded two higher-order DB factors (pros and cons), which were subdivided into five lower-order factors (perceived benefits of a plant-based diet, downsides of factory farming, health barriers, legitimation barriers and feasibility barriers). The pros and cons were summarised in a DB index. All DB factors and the DB index were tested for internal consistency (Cronbach's alpha ≥.70) and aspects of validity. The typical DB pattern of the pros and cons of behaviour change was confirmed: the cons outweighed the pros for consumers who did not intend to reduce meat consumption, while the pros outweighed the cons for consumers who intended to reduce meat consumption. The new DB scale for meat reduction has proven to be a suitable measure to gain insights into consumers' decision making and could be used to develop targeted meat reduction interventions.

Motivational Interviewing and Chronic Care Management Using the Transtheoretical Model of Change.

The number of Americans living with chronic health conditions has steadily increased. Chronic diseases are the leading causes of death and disability in the United States and cost the healthcare system an estimated $4.1 trillion dollars a year. The role of social workers in assisting patients in the management of their chronic diseases is vital. The behavioral health changes often required of chronic care management (CCM) patients require support and intervention by professionals to help the patient improve self-management of their chronic health conditions. Motivational interviewing (MI) is an evidence-based practice that helps people change by paying attention to the language patients use as they discuss their change goals and behaviors. Applying the principles and strategies of MI within the stages of change model (transtheoretical model of change) can help social workers better understand and assist patients receiving CCM. This article outlines specific strategies the social worker can use to address motivation at different stages of change.

The Sacred Space: Using Stages of Change Model With Motivational Interviewing to Promote Patient-Centered Healing.

OBJECTIVE: Help patients make necessary life changes to reach desired health outcomes. METHODS: By combining the transtheoretical stages of the change model with motivational interviewing, nurse practitioners can hone powerful skills to enable patients to make their desired life changes. RESULTS: Nurses and nurse practitioners can make a difference in patients' lives by connecting and partnering with them to create positive change for improved health outcomes. CONCLUSIONS: Nurse educators should provide opportunities for nurses at all levels to learn and incorporate these skills into their practice.

Digital Interventions to Enhance Readiness for Psychological Therapy: Scoping Review.

BACKGROUND: Psychological therapy is an effective treatment method for mental illness; however, many people with mental illness do not seek treatment or drop out of treatment early. Increasing client uptake and engagement in therapy is key to addressing the escalating global problem of mental illness. Attitudinal barriers, such as a lack of motivation, are a leading cause of low engagement in therapy. Digital interventions to increase motivation and readiness for change hold promise as accessible and scalable solutions; however, little is known about the range of interventions being used and their feasibility as a means to increase engagement with therapy. OBJECTIVE: This review aimed to define the emerging field of digital interventions to enhance readiness for psychological therapy and detect gaps in the literature. METHODS: A literature search was conducted in PubMed, PsycINFO, PsycARTICLES, Scopus, Embase, ACM Guide to Computing Literature, and IEEE Xplore Digital Library from January 1, 2006, to November 30, 2021. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology was applied. Publications were included when they concerned a digitally delivered intervention, a specific target of which was enhancing engagement with further psychological treatment, and when this intervention occurred before the target psychological treatment. RESULTS: A total of 45 publications met the inclusion criteria. The conditions included depression, unspecified general mental health, comorbid anxiety and depression, smoking, eating disorders, suicide, social anxiety, substance use, gambling, and psychosis. Almost half of the interventions (22/48, 46%) were web-based programs; the other formats included screening tools, videos, apps, and websites. The components of the interventions included psychoeducation, symptom assessment and feedback, information on treatment options and referrals, client testimonials, expectation management, and pro-con lists. Regarding feasibility, of the 16 controlled studies, 7 (44%) measuring actual behavior or action showed evidence of intervention effectiveness compared with controls, 7 (44%) found no differences, and 2 (12%) indicated worse behavioral outcomes. In general, the outcomes were mixed and inconclusive owing to variations in trial designs, control types, and outcome measures. CONCLUSIONS: Digital interventions to enhance readiness for psychological therapy are broad and varied. Although these easily accessible digital approaches show potential as a means of preparing people for therapy, they are not without risks. The complex nature of stigma, motivation, and individual emotional responses toward engaging in treatment for mental health difficulties suggests that a careful approach is needed when developing and evaluating digital readiness interventions. Further qualitative, naturalistic, and longitudinal research is needed to deepen our knowledge in this area.

Stages of dairy product consumption among Iranian female high school students based on transtheoretical model: The case of osteoporosis prevention.

Background: As nutritional needs increase in adolescence, dairy consumption can play a key role in health and disease prevention; however, unfortunately, inadequate consumption of milk and dairy products has often been reported in adolescents. Aim: The purpose of this study was to investigate the relation between decisional balance, self-efficacy, and the processes of change with the stages of change for dairy consumption in female high school students in Shaft county located in the west of Gilan Province, Iran. Methods: A total of 385 female high school students in Shaft County were studied through the census method in 2019. The data collection instrument was a valid and reliable questionnaire consisting of demographic information, stages of change and items of transtheoretical model constructs including the processes of change (cognitive process: consciousness-raising, dramatic relief, self-reevaluation, environmental reevaluation, and social liberation; behavioral process: self-liberation, counter conditioning, reinforcement management, stimulus control and helping relationships), decisional balance and self-efficacy. Data were analyzed using SPSS 21 software. Results: A total of 208 (54%), 53 (13.8%), 56 (14.5%), 32 (8.3%) and 36 (9.4%) students were in the pre-contemplate, contemplation, preparation, action and maintenance stages, respectively. As the subjects progressed through the stage of change for dairy consumption, an increase in the mean score of self-efficacy, decisional balance, and processes of change was observed (P < 0.01). Conclusion: The constructs of the transtheoretical model should be considered in designing educational interventions to promote dairy consumption with regard to the stage of change for dairy consumption in the subjects.

Towards OPtimal TIming and Method for promoting sUstained adherence to lifestyle and body weight recommendations in postMenopausal breast cancer survivors (the OPTIMUM-study): protocol for a longitudinal mixed-method study.

BACKGROUND: The majority of postmenopausal breast cancer (PMBC) survivors do not adhere to lifestyle recommendations and have excess body weight. In this group, this is associated with poorer health-related quality of life and an increased risk of type II diabetes mellitus, cardiovascular disease, second primary cancers, cancer recurrences, and mortality. Gaining and maintaining a healthy lifestyle and body composition is therefore important. It is unknown when and how sustained adherence to these recommendations can be promoted optimally in PMBC survivors. Therefore, the OPTIMUM study aims to identify the optimal timing and method for promoting sustained adherence to lifestyle and body weight recommendations in PMBC survivors. METHODS: The OPTIMUM-study has a mixed-methods design. To assess optimal timing, a longitudinal observational study will be conducted among approximately 1000 PMBC survivors. The primary outcomes are adherence to lifestyle and body weight recommendations, readiness for change, and need for support. Questionnaires will be administered at 4-6 months after cancer diagnosis (wave 1: during treatment and retrospectively before diagnosis), 1 year after diagnosis (wave 2: after completion of initial treatment), and 1.5 years after diagnosis (wave 3: during follow-up). Wave 2 and 3 include blood sampling, and either wearing an accelerometer for 7 days or completing a 3-day online food diary (randomly assigned at hospital level). To assess the optimal method, behavioural determinants of the primary outcomes will be matched with Behavior Change Techniques using the Behaviour Change Technique Taxonomy. Qualitative research methods will be used to explore perceptions, needs and preferences of PMBC survivors (semi-structured interviews, focus groups) and health care providers (Delphi study). Topics include perceptions on optimal timing to promote adherence; facilitators and motivators of, and barriers towards (sustained) adherence to recommendations; and acceptability of the selected methods. DISCUSSION: The OPTIMUM study aims to gain scientific knowledge on when and how to promote sustained adherence to lifestyle and body weight recommendations among PBMC survivors. This knowledge can be incorporated into guidelines for tailored promotion in clinical practice to improve health outcomes.

A pharmacist health coaching trial evaluating behavioural changes in participants with poorly controlled hypertension.

BACKGROUND: To investigate whether pharmacist health coaching improves progression through the stages of change (SOC) for three modifiable health behaviours; diet, exercise, and medication management in participants with poorly controlled hypertension. METHODS: In this four-month controlled group study two community-based pharmacists provided three health coaching sessions to 20 participants with poorly controlled hypertension at monthly intervals. Changes in participants' stages of change with respect to the modifiable health behaviours; diet, exercise, and medication management were assessed. To confirm the behaviour change outcomes, SOC were also assessed in a control group over the same period. RESULTS: Statistically significant changes in the modifiable health behaviours- medication management (d = 0.19; p = 0.03) and exercise (d = 0.85; p = 0.01) were apparent in participants who received health coaching and were evident through positive changes in the SOC charts. The participants in the control group did not experience significant changes with respect to the SOC. This was parallel to a decrease in mean systolic blood pressure from session one to session four by 7.53 mmHg (p < 0.05, d = - 0.42) in participants who received health coaching. Improvements to medication adherence was also apparent in these participants, evident from the mean scores for the Adherence to Refills and Medications Scale (ARMS), which decreased significantly from a mean of 15.60 to 13.05 (p < 0.05) from session one to four. CONCLUSIONS: Pharmacist health coaching produced promising health outcomes in participants with poorly controlled hypertension. Pharmacists were able to facilitate a positive behaviour change in participants. However, larger participant cohorts are needed to explore these findings further. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry ACTRN12618001839291 . Date of registration 12/11/2018.

Long-term changes of psychological factors regarding exercise in patients with type 2 diabetes after discharge and the effect of these changes on glycemic control.

[Purpose] In the medical treatment guidelines for type 2 diabetes, the utility of the approach using self-efficacy and stage of change has been previously demonstrated. Although the effects of short-term approaches have been shown, a few studies have examined long-term changes over time. The purpose of the present study was to investigate longitudinally the factors that affect the stage of change, self-efficacy for exercise, and glycemic control for 12 months in patients with type 2 diabetes after the intervention of the disease by receiving diabetes and glycemic control education. [Participants and Methods] The study included 29 patients with type 2 diabetes as participants who were able to follow up for 12 months after the intervention. The changes over time were investigated using stage of change and self-efficacy as psychological indicators of exercise. Factors affecting HbA1c values after 12 months of intervention were examined with information on diabetes and social background. [Results] There was no significant difference in self-efficacy for exercising at 3, 6, and 12 months after discharge. In contrast, participants in the stage of change showed a significant improvement at 6 and 12 months after discharge in comparison to 3 months after discharge. HbA1c values decreased at 12 months while comparing patients after 3 months and 12 months after discharge. The only factor affecting HbA1c value 12 months after discharge was the duration of diabetes. [Conclusion] The results suggested that stage of change and self-efficacy for exercise might have a little long-term effect on glycemic control.

The Effects of a Brief Motivational Intervention for Alcohol Use through Stages of Change among Nontreatment Seeking Injured Patients.

BACKGROUND: Little is known about the mechanisms of change underlying brief interventions and the patient characteristics that may affect them. The present study tested whether the stages of change mediate the effects of a BMI with and without a telephone booster relative to brief advice (i.e., multiple mediation). Further, the present study tested whether the effects of the BMI conditions on the stages of change were contingent on patients' alcohol use severity (i.e., moderated mediation). METHODS: The present study is a secondary analysis using data from injured adult patients at 3 trauma centers who were screened for inclusion in the study and randomly assigned to brief advice (n = 200), BMI (n = 203), or BMI with a telephone booster (n = 193) (Field et al., 2014). Participants completed a baseline assessment and 3-, 6-, and 12-month follow-up assessments that included self-report measures of the stages of change, alcohol use, and alcohol-related problems, as well as other variables of interest. RESULTS: The results demonstrated significant and consistent mediation at p < 0.05 wherein BMI with a telephone booster increased action at 3-month follow-up leading to reduced likelihood of at-risk drinking, less alcohol use, and fewer alcohol problems at both 6- and 12-month follow-up. However, moderated mediation analyses suggested that the effects of the BMI conditions on the stages of change were not contingent on patients' alcohol use severity. CONCLUSIONS: This study contributes to the understanding of stages of change as potential mechanisms of change in BMI. Directions for future research are discussed.

The impact of motivational interviewing on relapse to substance use among women in Iran: a randomized clinical trial.

BACKGROUND: Women in Iran are in great need of effective substance abuse services. The current study was conducted to investigate the effectiveness of motivational interviewing (MI) for women in treatment for drug use in Iran. METHOD: The sample (N = 60) included women in a drug treatment center in Qazvin (Iran) from August to December of 2017. The research sample included 60 female drug users randomly assigned to MI or Standard Care (SC). Prior to randomization women completed a baseline questionnaire and the Relapse Prediction Scale (RPS), which measures desire (urge) to use and probability of using/not using in risky situations (self-efficacy). MI consisted of eight 60-min group sessions over a 1-month period, twice weekly. At 2-months follow-up, data were gathered using a questionnaire similar to baseline. Mixed Model Analysis were used to determine group differences. RESULTS: Mean age of participants was 30 years and average addiction duration was 7 years. Although the scores of the desire to use and the probability of drug use were not significant before the intervention, after the intervention, scores on desire to use and probability of use improved about 81.1% (F: 2230.15, P < 0.001, degrees of freedom: 63, 15) and 81.9%, (F: 749.39, P < 0.001, degrees of freedom: 79, 77), respectively, compared to those of control group. CONCLUSION: The results showed that motivational interviewing could decrease desire to use and probability of use among female drug users. Motivational interviewing could play an important role in improving women's health in Iran. TRIAL REGISTRATION: IRCT registration number: IRCT20140907019077N4 Registration date: 2017-12-12, 1396/09/21 Registration timing: registered_while_recruiting Last update: 2017-12-12, 1396/09/21.

Vitamin D and UV exposure in construction workers-a randomized control trial using text messaging to promote positive behaviours.

BACKGROUND: The aim of this study was to determine whether a text messaging intervention (supported by a smartphone application) would be effective in the promotion of sun-safe behaviours. Both excessive and insufficient exposure to ultra-violet (UV) radiation were considered. METHODS: A randomized control crossover trial was conducted. 112 participants from nine sites in the United Kingdom contributed to the study. There were three intervention waves, two in winter (Vitamin D-focussed) and one in summer (UV exposure-focussed). Stages of Change, Standard Erythemal (UV) Dose and assayed blood samples (Vitamin D) were employed to evaluate the effectiveness throughout the 21-day data collection periods. RESULTS: The intervention was effective in promoting positive progression in Stages of Change for Vitamin D; and this in turn was predictive of increased Vitamin D levels in participants. More limited positive findings were found with respect to UV exposure. Overall, for those in the Intervention, Vitamin D levels were significantly predicted to increase during both of the winter data collection waves. CONCLUSIONS: Interventions of this type are recommended to promote healthy Vitamin-D levels in construction workers.

The validation of the Healthy and Unhealthy Eating Behavior Scale (HUEBS): Examining the interplay between stages of change and motivation and their association with healthy and unhealthy eating behaviors and physical health.

The purpose of the present research was to examine how self-determined and non-self-determined motivation for eating was related to healthy and unhealthy eating behaviors at different stages of change. In Study 1 (n = 360), the structure of a new scale designed to measure healthy and unhealthy eating behaviors based on recent recommendations of the Canadian Food Guide was examined through Principal Component Analysis. Study 2 (n = 711) retested the structure of the scale and also examined whether women reported different patterns of motivation and eating behaviors depending on their stage of change for eating regulation. In Study 3 (n = 264), moderated mediation models were used to examine if eating behaviors served to mediate the relationship between motivation and waist circumference, and whether stages of change moderated the link from motivation to eating behaviors. Overall, the studies provided evidence for the 2-factor structure of the scale, where the first factor represents healthy eating and the second factor represents unhealthy eating behaviors. It was also demonstrated that as women moved along the stages of change for eating regulation, they reported higher levels of self-determined motivation and lower levels of non-self-determined motivation, as well as a higher consumption of healthy foods and a lower consumption of unhealthy foods. Finally, findings indicated that healthy eating fully mediated the relationship between self-determined motivation and waist circumference, and that the relationship between self-determined motivation and healthy eating was moderated by stages of change. Together, these studies highlight the interactive roles of motivation and stages of change in their association with healthy and unhealthy eating behaviors, as well as the importance of healthy eating for a lower waist circumference.

Using behavioral science theory to enhance public health nursing.

The application of behavioral science theory is instrumental in advancing nursing research and practice. Nurses can benefit from a thorough understanding of theoretical perspectives related to health behavior change. Behavioral science theory can provide a conceptual context for understanding patient behavior, it can guide research on the determinants of health behavior and health service delivery, and it can offer alternative approaches to nursing practice that may improve the effectiveness of patient care. The aim of this paper is to provide some examples of behavioral theories that can be used in nursing research and practice, and provide an example of how one theory, Stages of Change (Transtheoretical Model), can be applied to older adult fall prevention. Given the critical role behavior plays in premature morbidity and mortality, public health nurses and researchers can benefit by broadening the use of theory in the design and implementation of interventions, using behavioral theory as their guide.

To contemplate or not to contemplate evaluating a preliminary intervention proposal in an outpatient setting: the contemplation therapy group.

PURPOSE: The concept for the contemplation group intervention was derived from motivational interviewing (MI) to support people suffering from an eating disorder who are reluctant to engage with treatment. This evaluation focuses on the contemplation group run by the eating disorder services in the Cardiff and Vale area between 2012 and 2016 to investigate the outcomes for participants and implications for working with people suffering from an eating disorder who are ambivalent about change. METHOD: Quantitative measures were used to assess eating disorder symptomatology, motivation to change and location within the stages of change model. A brief qualitative evaluation of client experiences was also included. RESULTS: While dropout was high, a number of patients displayed increased readiness for treatment at the end of the group or even started to engage in change-focussed therapy. Participants who completed the group described it as challenging but helpful. CONCLUSIONS: This evaluation shows that explorative contemplation of their ambivalence towards their eating disorder and treatment was helpful for the participants of the group and supported them in achieving more clarity and decisiveness regarding whether to engage in treatment or not. Further research is needed to evaluate long-term outcomes for patients who feel ambivalent towards treatment, and to explore what interventions can be used to help them. EVIDENCE LEVEL: Level IV: Evidence obtained from multiple time series with or without the intervention.

Acceptability of a Computer-Tailored Safer Sex Intervention for Heterosexually Active African Americans Attending an STI Clinic.

Since African Americans are disproportionately affected by HIV/AIDS, interventions that increase correct and consistent condom use are urgently needed. We report baseline acceptability data from a randomized controlled trial (RCT) testing the Tailored Information Program for Safer Sex, a computer-tailored intervention designed to increase correct and consistent condom use among low income, heterosexually active African Americans attending an urban sexually transmitted infection (STI) clinic. We enrolled 274 participants at baseline in an RCT-147 in the intervention group. The intervention had high acceptability, with a mean acceptability of 4.35 on a 5-point scale. We conducted a multiple regression analysis examining demographic, structural, and sexual risk characteristics that revealed only sex to be significantly (p < .01) associated with intervention acceptability. While women were more likely than men to find the intervention acceptable, overall the results indicated broad acceptability of this intervention to the target audience. eHealth interventions are a viable option for HIV prevention among African Americans visiting a publicly-funded STI clinic. We discuss implications of these results for the future application of such programs.