Purpose:
Programs of behavior change with education targeting application to lifestyle habits may result in changes in risk-related behavior and improved cardiovascular disease (CVD) outcomes. The purpose of this abstract is to describe the changes, as evidenced in the qualitative analyses of transcripts of 14 sessions of a 6-month peer support group intervention to foster risk-related behavioral change, and in final program interviews.
Method:
African American men (N=8), aged 45-83 years, from one Baptist church in NE U.S. participated in a peer-led behavior change program targeting Life’s Simple 7 (get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, stop smoking), over a 6-month period. Research staff monitored the hour-long peer intervention sessions by phone and recorded and transcribed the sessions. Qualitative analysis comprised thematic analyses of the textual content of the peer group sessions and transcripts of follow-up interviews to identify evidence in the text supporting the existence of shifting stages of change within the group over time. Self-reported stages of readiness to change related to the 7 CVD behavioral risk areas were also quantified using 7 contemplation ladders with rungs ranging from zero (“no thoughts of changing”) to 10 (“taking action to change”).
Results:
Over the course of the 6-month intervention, changes in group participants’ stages of change were evident. Six key themes emerged from the group sessions, including: (1) individuals’ resistance to change behaviors (weeks 1-2); (2) engagement through peer discussion of challenges and barriers (weeks 2-5); (3) awareness of physical benefits of change (weeks 2-24); (4) peer group cooperation for problem solving (weeks 3-24); (5) initiating health promotion inclusive of family and community (weeks 11-24); and (6) teaching others (weeks 18-24). The median difference in change in the contemplation ladders was <0; likely due to a ceiling effect due to the recruitment of motivated men who were ready to change. In the 6-month interviews, although men have changed behaviors positively over time, participants still reported challenges to changing and maintaining behaviors in different areas. This reveals that behaviors are continuing to evolve, and that in this shifting, behavior change is still an ongoing process as the men become more aware of their behaviors and increasingly view them in context of family and community.
Conclusions:
In this 6-month, intensive peer-led intervention, the micro-culture of the peer support group transformed from self-focused resistance to cohesion, then to other-oriented action. The data moved beyond Prochaska’s Stages of Change Model to break out and define a new paradigm of change that affected family and community and which will likely lead to longer term, continued changes and ongoing reinforcement.
