Enhancing organizational readiness for implementation: constructing a typology of readiness-development strategies using a modified Delphi process

Background Knowledge about the development of organizational readiness for implementation (ORI) is limited. ORI, referred to as the willingness and capacity of all relevant stakeholders to change practice, is critical for increasing the adoption rate of evidence-based practices and improving implementation outcomes. However, no methodology currently guides ORI’s enhancement or addresses differences in readiness needs across an organization. This study used the transtheoretical model (TTM) as a framework for classifying a well-established compilation of implementation strategies into three readiness stages: pre-contemplation, contemplation, and preparation. Methods A modified Delphi method was used to establish consensus among a panel of purposefully selected research and field implementation experts. The Delphi process involved three rounds of online questionnaires. The third round also included a live video discussion to clarify definitions in an effort to increase consensus among experts. Results Of the 73 strategies reviewed, the experts identified 75% (n = 55) as relevant for pre-implementation and reached a high-level agreement on the assignment of 7% (n = 5) of the strategies to the pre-contemplation stage (ORI-1), 25% (n = 18) to the contemplation stage (ORI-2), and 52% (n = 38) to the preparation stage (ORI-3). Several strategies were identified as relevant to more than one stage. Conclusions Participating experts were able to reach high-level agreement on the relevance of specific sets of implementation strategies to each of the three ORI stages. The lowest number of strategies was assigned to ORI-1 and the highest number to ORI-3. Given the overlap of strategies across ORI stages, there is a need to better understand the specific utilization of such strategies at different stages. Future studies are needed to empirically evaluate the relevance and applicability of this expert-informed typology based on implementers’ experiences in the field.

Impact of telephone support programme using telemonitoring on stage of change towards healthy eating and active exercise in people with prediabetes

Introduction This study evaluated the impact of a telephone support programme with telemonitoring on changes in healthy eating and active exercise in adults with prediabetes using the stage of change framework. Methods We performed a post hoc analysis using data from the Japan Diabetes Outcome Trial-1. A total of 2607 participants aged 20–65 years with impaired fasting glucose were recruited from the workplace/community in Japan and randomized to a 1-year telephone support programme intervention arm ( n = 1240) or self-directed control arm ( n = 1367). Participants in both arms received monthly data feedback from a weight scale and pedometer. The main outcome measure was the stages of change toward healthy eating and active exercise. The secondary outcome was fasting plasma glucose (FPG). Results After the 1-year intervention, the adjusted odds ratio of progressing to the action/maintenance stage in the intervention vs. control arm for healthy eating was 1.31 (95% confidence interval (CI) 1.21–1.43; p < 0.001), but that for active exercise was 1.07 (95% CI 0.99–1.15; p = 0.062). The intervention decreased FPG levels in participants in the contemplation stage, but not in the precontemplation, preparation and action/maintenance stages. Discussion These findings suggest that the telephone support programme by healthcare providers advanced the stage of changes toward healthy eating in people with prediabetes. In particular, it decreased FPG levels in the contemplation stage.

Predicting healthcare seeking behavior based on stated readiness to act: Development and validation of a prediction model

Introduction. A starting point of many digital health interventions informed by the Stages of Change Model of behavior change is assessing a person’s readiness to change. In this paper we use the concept of readiness to develop and validate a prediction model of health seeking behavior in the context of family planning. Methods. We conducted a secondary analysis of routinely collected, anonymized health data submitted by 4,088 female users of a free health chatbot in Kenya. We developed a prediction model of (future) self-reported action by splitting the data into training and test data sets and further split the training data into 10 folds for cross-validating the hyperparameter tuning step in model selection. We fit nine different classification models and selected the model that maximized the area under the receiver operator curve. We then fit the selected model to the full training dataset and evaluated the performance of this model on the holdout test data. Results. The model predicts who will visit a family planning provider in the future with high precision (0.93) and moderate recall (0.75). Using the Stages of Change framework, we concluded that 29 percent of women were in the “Preparation” stage, 21 percent were in the “Contemplation” stage, and 50 percent were in the "Pre-Contemplation stage. Discussion. We demonstrated that it is possible to accurately predict future healthcare seeking behavior based on information learned during the initial encounter. Models like this may help intervention developers to tailor strategies and content in real-time.

Future Care Plan at the Contemplation Stage Among Older Adults

Previous studies have shown that making future care planning often involves several steps. This is consistent with the transtheoretical model of behavior change which identified stages in which behavior changes over time and progresses through a series of six stages (Prochaska & Norcross, 2001). Although most studies on future care planning among older adults have examined the progression from the pre-contemplation stage to an action stage, little is known about the unique characteristics of older adults at the contemplation stage. Our sample included 409 randomly selected older adults in Cleveland, Ohio who were in the first wave of a longitudinal study of successful aging (µage = 78.8, SD=5.74). We used multivariate logistic regression to predict older adults who are more likely to have thought of their future care plans (contemplation stage). Results indicate several individual and relationship factors such as marital status, engaging in health behaviors (not smoking), being young old, and having personal transportation (OR=.42, .63, 2.81, and 1.73) account for contemplating future care. These findings underscore that several individual resources, as well as relationship status, are associated with contemplation stage of future care planning. The results reinforce the idea that future care planning is a stage-based behavior that people engage in, rather than a stand-alone activity.

STAGES OF SMOKING CESSATION AMONG ADULT CURRENT SMOKERS IN MALAYSIA: FINDINGS FROM THE NATIONAL E-CIGARETTE SURVEY 2016

Identification of the stages of smoking cessation among smokers is essential to improve the rate of smoking cessation. The aims of this study were to determine the prevalence and factors associated with stages of smoking cessation across the demographic distribution of adult smokers in Malaysia. Data were derived from a population-based study among Malaysian adults aged 18 years and above. Face-to-face interviews were carried out by trained staff using a validated questionnaire to obtain data related to smoking from 4,288 selected respondents. Of 4,288, 438 respondents are current smokers. Multivariable logistic regression analysis was used to determine factors associated with stage of smoking cessation. Approximately 60% (n=269/438) of the current smokers were in the pre-contemplation stage and 40% (n=169/438) were in the contemplation and preparation stages of smoking cessation. The proportion of pre-contemplators was higher among smokers with higher levels of nicotine addiction (71.3%), lower education attainment (71.4%), and those who were single/widowed/divorced (66.9%). Multivariable analysis showed that males, and those who reported low to high level of nicotine addiction were more likely to be in the pre-contemplation stage whilst those in the older age groups were more likely to be in the advanced stage of smoking cessation. The study revealed that the majority of current smokers in Malaysia had no intention to quit smoking within 6 months. Specific interventions targeting males, young adults and smokers with low to high nicotine addiction should be introduced to ensure the smokers proceed to the advanced stage of smoking cessation.

Improving Physical Activity Levels and Psychological Variables on University Students in the Contemplation Stage

This study aimed to investigate the effects of a physical activity intervention, based on self-determination theory and the transtheoretical model, on university students in the contemplation stage. Participants: 42 students, in the contemplation stage at baseline, were randomly assigned to an experimental group (16 women, 2 men; M age = 19.1 ± 1.15) and a control group (18 women, 2 men; M age = 20.1 ± 5.7). Methods: Physical activity was measured at different moments by accelerometry. Other cognitive variables were measured by self-reported scales. Results: We did not find any significant increases in students’ physical activity in favor of the intervention group. Intragroup analyses indicate that the intervention has an effect on physical activity (moderate-to-vigorous physical activity), basic psychological needs, and intrinsic and extrinsic motivation. Conclusions: Results partially demonstrate that applying social cognitive theories seems to be effective in improving physical activity and cognitive variables in university students in the contemplation stage

Factors Affecting the Behavior and Stages of Readiness to Change Exercise Behaviour among University Students

The purpose of this research was to evaluate the readiness of exercise behaviors of University students. The 400 students were selected using the formula of Yamane and stratified systematic sampling. The instrument used to collect the data was behavioral assessment. The data were analysed using an independent t-test, which resulted in a level of 0.05 level of significance. The results showed the overview of students for the stages of exercise behaviour were in the contemplation stage of 44.10%. In addition, the male and female students have exercise behaviour, according to the mentioned theory were in the contemplation stage.

Texting Older Sisters to Step: The TOSS Study

The purpose of our two-phase study was to develop acceptable text messages to increase physical activity. Four focus groups (two for each phase) were conducted with older African American women who had access to texting-capable mobile phones and were in the contemplation stage for physical activity. The mean age of Phase 1 participants ( n = 12) was 71 and ranged from 65 to 86 years. Content analysis was used to identify fundamental themes that were later used to develop text messages. Six categories emerged from the data and 31 text messages were developed based on focus group input and national recommendations. The mean age of Phase 2 participants ( n = 9) was 67 and ranged from 65 to 75 years. Descriptive statistics revealed 100% of participants understood all messages. When messages were evaluated individually, a minimum of 78% felt each message motivated activity and 67% said lengths were perfect. Findings identified messages that were relevant and potentially motivational to stimulate physical activity among this population.

Patient Motivation to Change Behavior and to Abstain from Alcohol in Songklanagarind Hospital

Objective: To investigate the motivation to change behavior for reduce binge drinking and to abstain from alcohol.Material and Method: The subjects of this study were 40 patients diagnosed with alcohol dependence and hospitalized in the psychiatric ward at Songklanagarind Hospital between September 2015 and January 2017. Selfadministers questionnaires consist of questions regarding general characteristics, drinking behavior, alcoholic treatment record, the contemplation ladder questionaire, and the University of Rhode Island Change Assessment Scale (URICA) questionaire. The data were analyzed using descriptive statistics and are presented as a percentage, average, and standard deviation.Results: This is a cross-sectional study. There were 40 male alcoholic patients: average age was 48.2 years; 85.0% of subjects lived with their spouse; and 45.0% were government officers; 47.5% of participants’ motivation to change behavior was in the action stage; 37.5% was in the preparation stage; 10.0% was in the contemplation stage, and 5.0% was in the pre-contemplation stage. Concerning the motivation to abstain from alcohol: 65.0% were in the contemplation stage and 35.0% in the pre-contemplation stage.Conclusion: The study found that participants’ motivation to change their behavior was in the action stage and were in the motivation to abstain from alcohol contemplation stage. The results can lead to plan an efficient treatment which the patients in action stage need a plan to relapse prevention while the patients in pre-contemplation stage need supportive motivate to change though and behavior to be in action stage.

Estágios de mudança de comportamento para a atividade física em adolescentes da Região Amazônica

DOI: http://dx.doi.org/10.5007/1980-0037.2017v19n4p493 The aim of this study was to estimate the prevalence of stages of behavior change (SBC) for physical activity and to verify the associated demographic and economic factors, in adolescents from the Amazon. A total of 2,517 adolescents (aged 14-19 years) from public high schools participated of the study. SBC for physical activity, demographic (sex, age, school year, school shift and residence area) and economic factors (occupational status, family income and maternal schooling) were investigated. The associations between SBC and independent variables were tested by multinomial logistic regression. Most adolescents were in the maintenance stage (40.8%) and the minority was in pre-contemplation stage (9.0%). Female adolescents were more likely of being in the action (OR=1.44; CI95%=1.14-1.81), preparation (OR=2.71; CI95%=2.14-3.44), contemplation (OR=2.89; CI95%=2.25-3.69) and pre-contemplation (OR=2.91;CI 95%=2.16-4.00) stages compared to male adolescents. Adolescents aged 16-17 years were less likely of being in the action stage (OR=0.71; CI95%=0.53-0.94) and those aged 18-19 years were more likely of being in the preparation stage (OR=1.50; CI95%=1.04-2.16) compared to those aged 14-15 years. Family income of six minimum wages or more was associated to higher chances of being in the action (OR=2.09; CI95%=1.38-3.17), preparation (OR=2.02; CI95%=1.31- 3.12) and contemplation (OR=1.87; IC95%=1.18-2.95) stages. Adolescents who worked were less likely of being in the pre-contemplation stage (OR=0.45; CI95%=0.27-0.74), compared to those who do not work. Most of adolescents were in the maintenance stage for physical activity. The factors associated to SBC were female sex, age groups of 16-17 years and 18-19 years, income of six minimum wages or more and work.