Transtheoretical individualized multimedia expert systems targeting adolescents' health behaviors

doi:10.1016/S1077-7229(99)80025-X

Cognitive and Behavioral Practice

Volume 6, Issue 2, Spring 1999, Pages 144-153

https://doi.org/10.1016/S1077-7229(99)80025-X Get rights and content

The transtheoretical model has advanced research and practice for many health behavior changes among adults, but few applications have been developed and applied among adolescents. This paper will describe an innovative and promising computer-based technology for standardized assessment and individualized theory-based intervention delivery called expert systems. Two different studies utilizing multimedia expert systems technology for assessing and intervening with adolescents targeting several health behaviors will be described. One study includes high school students and targets smoking cessation or prevention, sun protection, and dietary fat reduction. The other study includes urban adolescent female clients recruited in family planning clinics and targets condom adoption and either smoking cessation or prevention. The advantages and disadvantages of expert systems technology are reviewed. Multimedia expert system technology has the potential to enhance health promotion and adherence by integrating the strongest components from both clinical and public health models of intervention.

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We conducted a 9-month, longitudinal randomized controlled trial with a multisite recruitment strategy including clinic, university, and social referrals, and compared the CAMI with didactic educational counseling in 572 female adolescents with a mean age of 17 years (SD = 2.2 years; range = 13-21 years; 59% African American) who were at risk for pregnancy and sexually transmitted diseases. The primary outcome was the acceptability of the CAMI according to self-reported rating scales. The secondary outcome was the reduction of pregnancy and sexually transmitted disease risk using a 9-month, self-report timeline follow-back calendar of unprotected sex.
The CAMI was rated easy to use. Compared with the didactic educational counseling, there was a significant effect of the intervention which suggested that the CAMI helped reduce unprotected sex among participants who completed the study. However, because of the high attrition rate, the intent to treat analysis did not demonstrate a significant effect of the CAMI on reducing the rate of unprotected sex.
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The Cronbach alpha coefficients for the Turkish form of the SPBS (α = .74) and its sunscreen (α = .88) and hat use (α = .70) subscales were found to be ≥.70 while the sun avoidance subscale was calculated to be .67. The item-total score correlation between the scale and its subscales was ≥.26 and the test-retest correlations were found to be ≥.51. The CFA results verified the 8-item, 3-factor Turkish version of the SPBS. The confirmatory factor loadings for the scale were .45–.80 for sun avoidance, .72–.93 for sunscreen use, and .66–.83 for hat use. In particular, SPBS and sunscreen use (p < .001) exhibited significantly high mean scores among girls and economically better backgrounds (p = .007, p < .001, respectively). In addition, SPBS (p = .004) and hat use (p < .001) revealed that the mean scores were significantly high in younger adolescents.
The SPBS was found to be valid and reliable and its psychometric characteristics acceptable. The scale can be used to measure the behavior of Turkish adolescent populations with respect to sun protection.
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To develop and validate an instrument to assess environmentally conscious eating (Green Eating [GE]) behavior (BEH) and GE Transtheoretical Model constructs including Stage of Change (SOC), Decisional Balance (DB), and Self-efficacy (SE).
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Citation Excerpt :
For both follow-up reports, they were also compared to their prior assessment. More details regarding TTM-tailored intervention protocols can be found elsewhere (Redding et al., 1999; Velicer and Prochaska, 1999). The intervention targeted the following dietary changes: 1) moderating intake of high fat foods, 2) substituting lower fat foods such as reduced fat dairy products for higher fat products, 3) modifying cooking techniques to reduce fried foods, and 4) increasing consumption of healthful foods such as fruits, vegetables and whole grains.
Longitudinal predictors of dietary behavior change are important and in need of study. This secondary data analysis combined primary data across three randomized trials to examine transtheoretical model (TTM) and specific dietary predictors of successful dietary change at 12 and 24 months separately in treatment and control groups (N = 4178). The treatment group received three TTM-tailored print interventions over 12 months between 1995 and 2000. Chi-square and MANOVA analyses were used to examine baseline predictors of dietary outcome at 12 and 24 months. Last, a multivariable logistic regression was conducted with all baseline variables included. Across all analyses in both treatment and control groups, the most robust predictors of successful change were for TTM-tailored treatment group, preparation stage of change, and increased use of dietary behavior variables such as moderating fat intake, substitution of lower fat foods, and increasing intake of healthful foods. These results provide strong evidence for treatment, stage and behavioral dietary severity effects predicting dietary behavior change over time, and for targeting these variables with the strongest relationships to outcome in interventions, such as TTM-tailored dietary interventions.
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^*: This research was partially supported by Grants #CA50087, #CA63745, #CA27821 (P.I.-J.O. Prochaska) from the National Cancer Institute and an Administrative Supplement from the Office of Women's Health to C. A. Redding. Portions of this article were presented at the annual meeting of the Association for Advancement of Behavior Therapy in Atlanta, GA, November 1997, and the Society of Behavioral Medicine in New Orleans, LA, March 1998. Authors also wish to gratefully acknowledge all the input from our various collaborators and participants on projects, as well as the assistance and expertise in the areas of systems development and programming (Guy Natelli) and multimedia components (David Masher).

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Special Series: Adolescent HealthTranstheoretical individualized multimedia expert systems targeting adolescents' health behaviors*

Addictive Behaviors

Journal of Adolescent Health

Preventive Medicine

Addictive Behaviors

Addictive Behaviors

Addictive Behaviors

Preventive Medicine

Addictive Behaviors

Addictive Behaviors

Patient Education and Counseling

Addictive Behaviors

Integrating individual and public-health perspectives for treatment of tobacco dependence under managed health care: A combined stepped-care and matching model

Annals of Behavioral Medicine

Social foundations of thought and action: A social cognitive theory

Examination of the psychometric properties of the short form of the adolescent dietary fat reduction decisional balance questionnaire

Technology, experimentation, and the quality of survey data

Science

Improving dietary behavior: The effectiveness of tailored messages in primary care settings

American Journal of Public Health

Self-efficacy in weight management

Journal of Consulting and Clinical Psychology

Self-efficacy and the addictive behaviors

Journal of Social and Clinical Psychology

The process of smoking cessation: An analysis of precontemplation, contemplation and preparation stages of change

Journal of Consulting and Clinical Psychology

Preventing high-risk behavior

American Journal of Public Health

Stage of change for dietary fat reduction in adolescents

Efficacy of an expert system intervention for dietary fat reduction

Computer-based health promotion: Combining technological advances with problem-solving techniques to effect successful health behavior changes

Annual Review of Public Health

Development of transtheoretical model constructs for sun protection behaviors among adolescents

Evaluation of motivationally tailored vs. standard self-help physical activity interventions at the workplace

American Journal of Health Promotion

The stages and processes of exercise behavior change in a worksite sample

Health Psychology

Adolescents' readiness to start or quit cigarette smoking: A sex and race comparison

Annals of Behavioral Medicine

Computer-based smoking cessation interventions in adolescents: Description, feasibility, and six-month follow-up findings

Substance Use & Misuse

Examination of the smoking processes of change model in adolescents

Verifying the smoking decisional balance model in adolescents

Special Series: Adolescent Health
Transtheoretical individualized multimedia expert systems targeting adolescents' health behaviors*