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Empiric validation of a process for behavior change

  • Original Research
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Translational Behavioral Medicine

Abstract

Most behavior change trials focus on outcomes rather than deconstructing how those outcomes related to programmatic theoretical underpinnings and intervention components. In this report, the process of change is compared for three evidence-based programs’ that shared theories, intervention elements and potential mediating variables. Each investigation was a randomized trial that assessed pre- and post- intervention variables using survey constructs with established reliability. Each also used mediation analyses to define relationships. The findings were combined using a pattern matching approach. Surprisingly, knowledge was a significant mediator in each program (a and b path effects [p<0.01]). Norms, perceived control abilities, and self-monitoring were confirmed in at least two studies (p<0.01 for each). Replication of findings across studies with a common design but varied populations provides a robust validation of the theory and processes of an effective intervention. Combined findings also demonstrate a means to substantiate process aspects and theoretical models to advance understanding of behavior change.

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References

  1. Institute of Medicine. Health and behavior: the interplay of biological, behavioral, and societal influences; Committee on Health and Behavior: Research, Practice and Policy Board on Neuroscience and Behavioral Health. Washington, DC: National Academy Press; 2001.

    Google Scholar 

  2. Avery KNL, Donovon JL, Horwood J, et al. Behavior theory for dietary interventions for cancer prevention: a systematic review of utilization and effectiveness in creating behavior change. Cancer Causes Control. 2013; 24: 409-420.

    Article  PubMed  Google Scholar 

  3. Davies P, Walker AE, Grimshaw JM. A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Implement Sci. 2010; 5: 1-6.

    Article  Google Scholar 

  4. Taylor N, Conner M, Lawton R. The impact of theory on the effectiveness of worksite physical activity interventions: a meta-analysis and meta-regression. Health Psychol Res. 2012; 6: 33-73.

    Google Scholar 

  5. Goldberg L, MacKinnon DP, Elliot DL, et al. The adolescents training and learning to avoid steroids program: preventing drug use and promoting healthy behaviors. Arch Pediat Adolesc Med. 2000; 154: 332-338.

    Article  CAS  Google Scholar 

  6. Elliot DL, Goldberg L, Moe EL, et al. Preventing substance use and disordered eating: initial outcomes of the ATHENA (athletes targeting healthy exercise and nutrition alternatives) program. Arch Pediatr Adolesc Med. 2004; 158: 1043-1049.

    Article  PubMed  Google Scholar 

  7. Elliot DL, Goldberg L, Moe EL, et al. Long-term outcomes of the ATHENA (Athletes Targeting Healthy Exercise & Nutrition Alternatives) program for female high school athletes. J Alcohol Drug Educ. 2008; 52: 73-92.

    PubMed  PubMed Central  Google Scholar 

  8. Elliot DL, Goldberg L, Kuehl KS, et al. The PHLAME study: process and outcomes of two models of behavior change. J Occup Environ Med. 2007; 49: 204-213.

    Article  PubMed  Google Scholar 

  9. MacKinnon DP, Elliot DL, Thoemmes F, et al. Long-term effects of a worksite health promotion program for firefighters. Am J Health Behav. 2010; 34: 695-706.

    Article  PubMed  Google Scholar 

  10. Mabry L, Elliot DL, MacKinnon DP, et al. Understanding the durability of a fire department wellness program. Am J Health Behav. 2013; 37: 693-702.

    Article  PubMed  PubMed Central  Google Scholar 

  11. MacKinnon DP, Goldberg L, Clarke GN, et al. Mediating mechanisms in a program to reduce intentions to use anabolic steroids and improve exercise self-efficacy and dietary behavior. Prevention Sci. 2001; 2: 15-28.

    Article  CAS  Google Scholar 

  12. Ranby KW, Aiken LS, MacKinnon DP, et al. A mediation analysis of the ATHENA intervention: reducing athletic-enhancing substance use and unhealthy weight loss behaviors. J Pediatr Psychol. 2009; 34: 1069-1083.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ranby KW, MacKinnon DP, Fairchild AJ, et al. The PHLAME (Promoting Healthy Lifestyles: Alternative Models’ Effects) firefighter study: testing Mediating mechanisms. J Occup Health Psychol. 2011; 16: 501-513.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rosenstock IM. The health belief model and preventive health behavior. Health Educ Monogr. 1974; 2: 354-386.

    Article  Google Scholar 

  15. Ajzen I. The theory of planned behavior. Org Behav Human DeciProc. 1991; 50: 179-211.

    Article  Google Scholar 

  16. Bandura A. The evolution of social cognitive theory. In: Smith KG, Hitt MA, eds. Great minds in management. Oxford: Oxford University Press; 2005.

    Google Scholar 

  17. Chen H-T. Theory-driven evaluations. Newbury Park, CA: Sage; 1990.

    Google Scholar 

  18. Bandura A. Social cognitive theory of self-regulation. Organizational Behav Human Disease Proc. 1991; 50: 248-287.

    Article  Google Scholar 

  19. Frankham J. Peer education: unauthorized version. Brit Educ Research J. 1998; 24: 179-193.

    Article  Google Scholar 

  20. Allen VL, Wilder DA. Social comparison, self evaluation, and conformity to the group. In: Suls JM, Miller RL, eds. Social comparison processes: theoretical and empirical perspectives. New York, NY: Hemisphere; 1977: 187-208.

    Google Scholar 

  21. Webel AR, Okonsky J, Trompeta J, et al. A systematic review of the effectiveness of peer-based interventions on health-related behaviors in adults. Am J Public Health. 2010; 100: 247-253.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Engelmann S, Carnine DW. Theory of instruction: principles and applications. New York, NY: Irvington; 1982.

    Google Scholar 

  23. Hollingsworth J, Ybarra S. Explicit direct instruction: the power of the well-crafted and well taught lesion. DataWORKS Educational Research: Fowler, CA; 2009.

    Google Scholar 

  24. Knowles MS, Holton EF, Swanson RA. The adult learner (seventh edition). Oxford, England: Elsevier, Inc.; 2011.

    Google Scholar 

  25. Watkins CL. Project follow through: a story of the identification and neglect of effective instruction. Youth Policy. 1988; 10(7): 7-11.

    Google Scholar 

  26. Michie S, Abraham C, Whittington C, et al. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009; 28: 690-701.

    Article  PubMed  Google Scholar 

  27. Katzenbach JR, Smith DK. The discipline of teams. Harv Bus Rev. 1993; 71: 162-171.

    Google Scholar 

  28. Guzzo RA, Dickson MW. Teams in organizations: research on performance effectiveness. Annu Rev Psychol. 1996; 47: 307-338.

    Article  CAS  PubMed  Google Scholar 

  29. Chen G, Kaufer R. Toward a systems theory of motivated behavior in work teams. Res Organizational Behav. 2006; 27: 223-267.

    Article  Google Scholar 

  30. Siemsen E, Balasubramanian S, Roth A. Incentives induce task-related effort, helping, and knowledge sharing in work-groups. Manag Sci. 2007; 53: 1533-1550.

    Article  Google Scholar 

  31. MacKinnon DP. Introduction to statistical mediation analysis. New York, NY: Lawrence Erlbaum Associates; 2008: 47-77.

    Google Scholar 

  32. Mackinnon DP, Fairchild AJ. Current directions in mediation analysis. Current Directions Psychol Sci. 2009; 18: 16.

    Article  Google Scholar 

  33. Lockwood CM, DeFrancesco CA, Elliot DL, et al. Mediation analyses: applications in nutrition research and reading the literature. J Am Diet Assoc. 2010; 110: 753-762.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sallis JF, Cervero RB, Ascher W, et al. An ecological approach to creating more physically active communities. Annu Rev Public Health. 2006; 27: 297-322.

    Article  PubMed  Google Scholar 

  35. Kuehl KS, Elliot DL, Goldberg L, et al. Economic benefit of the PHLAME wellness programme on firefighter injury. Occup Med. 2013; 63: 203-209.

    Article  CAS  Google Scholar 

  36. Muthe ´NB, Muthe ´NL. Mplus 5 User’s Guide. Los Angeles, CA: Muthe´n & Muthe´n; 2008.

    Google Scholar 

  37. Raudenbush SW, Bryk AS. Hierarchical linear models: applications and data analysis methods (2nd edition). Newbury Park, CA: Sage; 2002.

    Google Scholar 

  38. MacKinnon DP, Fritz MS, Williams J, et al. Distribution of the product confidence limits for the indirect effect program PRODCLIN. Behav Res Methods. 2007; 39: 384-389.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Trochim WMK. Pattern matching, validity, and conceptualization in program evaluation. Eval Rev. 1985; 9: 575-604.

    Article  Google Scholar 

  40. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analyses: conventional criteria versus new alternatives. Struct Equ Model. 1999; 6: 1-55.

    Article  Google Scholar 

  41. Cook TD, Cooper H, Cordray DS, et al. Meta-analysis for explanation: a casebook. New York, NY: Sage; 1992.

    Google Scholar 

  42. Becker BJ. Model-based meta-analysis. In: Cooper H, Hedges LV, Valentine JC, eds. The handbook of research synthesis and meta-analysis. 2nd ed. New York, NY: Russell Sage; 2009: 377-395.

    Google Scholar 

  43. Contento I, Balch GI, Bronner YL, et al. The effectiveness of nutrition education and implications for nutrition education policy, programs, and research: a review of research. J Nutr Educ. 1995; 27: 277-418.

    Google Scholar 

  44. Lorig KR, Holman HR. Self-management and education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003; 26: 1-7.

    Article  PubMed  Google Scholar 

  45. Rothman A, Kiuiniemi M. Treating people with information: an M. Treating people with information: an analysis and review of approaches to community risk information. J Natl Cancer Inst Monogr. 1999; 25: 44-57.

    Article  PubMed  Google Scholar 

  46. MacKinnon DP, Johnson CA, Pentz MA, et al. Mediating mechanisms in a school-based drug prevention program: first-year effects of the Midwestern Prevention Project. Health Psychol. 1991; 10: 164-172.

    Article  CAS  PubMed  Google Scholar 

  47. Shrum LT, Liu M, Nespoli M, et al. Persuasion in the market place. In: Dillard JP, Shen L, eds. The persuasion handbook. Thousand Oaks, CA: Sage; 2012: 314-330.

    Google Scholar 

  48. Sörensen S, Pinquart M, Duberstein P. How effective are interventions with caregivers? An updated meta-analysis. Gerontologist. 2002; 42: 356-372.

    Article  PubMed  Google Scholar 

  49. Estabrooks PA. Sustaining exercise participation through group cohesion. Exerc Sport Sci Rev. 2000; 28: 1-5.

    Google Scholar 

  50. Smith-Ray RL, Mama S, Reese-Smith JY, et al. Improving participation rates for women of color in health research: the role of group cohesion. Prev Sci. 2012; 13: 27-35.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

ATLAS research was supported by the National Institute on Drug Abuse grant DA07356. The ATHENA project was supported by the National Institute on Drug Abuse DA11748. PHLAME was supported by the National Institute on Arthritis and Musculoskeletal and Skin Diseases AR45901 and National Cancer Institute CA105774. Dr. Moe was supported by AHRQ K12 HS019456 01. The funders played no role in the design, conduct, or analysis of these studies, nor in the interpretation and reporting of findings. All authors had full access to all of the data and take responsibility for the integrity of the data and the accuracy of the data analysis.

Compliance with ethical standards

ᅟ

Conflict of interest

ATLAS and ATHENA are made available for distribution through the Center for Health Promotion Research at Oregon Health & Science University (OHSU). Drs. Elliot and Goldberg have a financial interest in the sale of these products. Since completion of the original research, PHLAME is being enhanced and commercialized through an STTR grant (TR000357). Dr. Goldberg and Dr. Kuehl have a financial interest from the commercial sale of that product. These potential conflicts of interest have been reviewed and managed by the OHSU Conflict of Interest in Research Committee at OHSU. Drs. MacKinnon, Ranby and Moe have no conflict of interest.

Adherence to ethical standards

All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Author information

Authors and Affiliations

  1. Division of Health Promotion and Sports Medicine; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road CR110, Portland, OR, 97239-3098, USA

    Diane L Elliot MD, Linn Goldberg MD, Kerry S Kuehl MD, DrPH & Esther L Moe PhD, MPH

  2. Department of Psychology, Arizona State University, Tempe, AZ, 85287-1104, USA

    David P MacKinnon PhD

  3. Department of Psychology, University of Colorado Denver, Denver, CO, 80217-3364, USA

    Krista W Ranby PhD

Authors
  1. Diane L Elliot MD
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  2. Linn Goldberg MD
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  3. David P MacKinnon PhD
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  4. Krista W Ranby PhD
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  5. Kerry S Kuehl MD, DrPH
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  6. Esther L Moe PhD, MPH
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Corresponding author

Correspondence to Diane L Elliot MD.

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Implications

Practice: A team-centered intervention using peer-led curricula and individual and team level behavioral monitoring appears to be an effective model for health promotion.

Policy: Replication of programs and translation in new settings can be informed by selecting those with confirmed theoretical and process structures.

Research: Combining the patterns of mediation findings across studies can be used to assist filling the knowledge gap concerning defining effective processes of behavior change.

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Elliot, D.L., Goldberg, L., MacKinnon, D.P. et al. Empiric validation of a process for behavior change. Behav. Med. Pract. Policy Res. 6, 449–456 (2016). https://doi.org/10.1007/s13142-015-0343-y

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  • DOI: https://doi.org/10.1007/s13142-015-0343-y

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