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This study tested the applicability of the Transtheoretical Model of Behavior Change in predicting early termination, appropriate termination, and ongoing treatment of Hispanic battered women residing at domestic violence shelters. Self-efficacy, decisional balance, and acculturation were examined in relation to the applicability of this model with the Hispanic women population. One hundred and eight women residing in two shelters for survivors of domestic violence, located in the Dallas/Fort Worth metroplex, were asked to provide information regarding the problems in their relationships, the pull and the strain of their relationship, their level of temptation to stay in the abusive relationship, and how confident they felt that they would not return to their abuser (The Process of Change in Abused Women Scales- PROCAWS). In addition, the women were asked to complete a questionnaire regarding their level of acculturation. This study confirmed the stage of change profiles found in a population of battered women as well as in other clinical populations and the results suggest that this model is applicable to Hispanic populations. The results indicated that the women in this sample could be meaningfully grouped according to their level of involvement in different stages of change. Furthermore, this study provided support for the validity of this theory by finding significant relationships among the profiles of change and the intervening variables that moderate movement across the stages of change. The women in this study differed with regard to their level of temptation to stay in their relationships and the amount of cons they to making changes. The findings also confirmed that the Transtheoretical Model can be used to predict termination status from domestic violence shelter programs. Although there were no significant differences in termination status among the women with different stage of change profiles, a trend existed that women in earlier stages of change terminated earlier and women in later stages of change terminated appropriately. Overall, the results of this study provide evidence for the applicability of the Transtheoretical Model and the usefulness of the PROCAWS in identifying profiles of change that can potentially guide treatment interventions and predict early termination with the Hispanic population.

Para que o indivíduo esteja engajado no uso do Aparelho de Amplificação Sonora Individual (AASI), é necessário que esteja motivado no seu processo de reabilitação e o profissional, tendo como ponto de partida a identificação do estágio motivacional do paciente, poderá apoiá-lo ao longo desse processo. Neste estudo foram realizados 2 experimentos distintos. O experimento 1 teve como objetivo caracterizar os perfis estabelecidos pela análise de clusters da Escala de Estágios de Mudança para Deficientes Auditivos (URICA-Audição), com base nos estágios motivacionais para a mudança em pacientes com deficiência auditiva. O experimento 2 teve como objetivo verificar se a URICA-Audição é sensível na identificação dos estágios de mudança em indivíduos submetidos à reabilitação auditiva. No experimento 1, foram analisados 200 protocolos preenchidos por indivíduos candidatos e usuários de AASI, com idade entre 24 e 94 anos, sendo 52 candidatos e 148 usuários de AASI há pelo menos um mês. Foi aplicada a URICA-Audição, composta por 25 itens divididos em cinco subescalas, com cinco itens cada: Pré-contemplação, Contemplação, Preparação, Ação e Manutenção. Para a análise dos resultados, foi realizada a Análise de Cluster Hierárquica por meio do método de centroides. Esta análise resultou em um total de 16 clusters distintos e, na solução encontrada, 167 sujeitos (83,5% da amostra) foram distribuídos em 8 clusters principais que continham mais de 10 participantes cada; 21 sujeitos (10,5% da amostra) se distribuíram em outros 3 clusters menores com 6 a 9 participantes; e 12 sujeitos (6% da amostra) se distribuíram em 5 clusters com 1 a 4 participantes cada. Dessa forma, verificou-se que os perfis dos pacientes subdividem-se em mais do que apenas 4 ou 5 estágios, como que em um continuum e, que a URICA-Audição é uma medida que pode, potencialmente, ser utilizada para avaliar onde os pacientes encontram-se no decorrer do seu processo de reabilitação auditiva. No experimento 2, foi realizado um estudo com avaliação pré e pósintervenção em usuários de AASI. Os participantes participaram em 4 sessões de reabilitação auditiva e responderam questionários avaliativos no início e no final da pesquisa. Os resultados indicaram que houve diferença nos momentos pré e pós-intervenção, no fator Ação/Manutenção da amostra estudada, assim como, na prontidão para a mudança do grupo. Houve correlação significante entre o tempo de uso do AASI na pós-intervenção com o estágio de Ação/Manutenção. Toda a amostra do presente estudo teve progressão nos estágios de mudança após a reabilitação auditiva. Apesar da amostra reduzida, foi possível realizar um estudo de reabilitação auditiva utilizando os preceitos do MTT, no entanto, é necessária a realização de outros estudos visando estabelecer estratégias de aconselhamento em reabilitação auditiva para cada estágio de mudança de comportamento. / In order for the individual to be engaged in the use of the Hearing Aid (HA), it is necessary that he is motivated in his rehabilitation process and starting with the identification of the patient\'s motivational stage the professional can support him throughout this process. There were performed two different experiments in this study. Experiment 1 aimed to characterize the profiles established by the clusters analysis of the Stages of Change for the Hearing Impaired Scale (URICA-Hearing) based on the motivational stages for change in patients with hearing impaired. Experiment 2 had as objective to verify if the URICA-Hearing is sensitive in the identification of the stages of change in individuals submitted to auditory rehabilitation. In the Experiment 1, two hundred protocols were filled out by candidates and users of HA, aged between 24 and 94 years, of which 52 were candidates and 148 were users of HA for at least one month. It was applied the URICA-Hearing that is composed of 25 items divided into five subscales, with five items each subscale: Pre-contemplation, Contemplation, Preparation, Action and Maintenance. For the analysis of the results, the Hierarchical Cluster Analysis was performed by means of the centroid method. This analysis resulted in a total of 16 distinct clusters and, in the solution found, 167 subjects (83.5% of the sample) were distributed in 8 main clusters that contained more than 10 participants each; 21 subjects (10.5% of the sample) were distributed in 3 other smaller clusters with 6 to 9 participants; and 12 subjects (6% of the sample) were distributed in 5 clusters with 1 to 4 participants each. Thus, it was verified that patients\' profiles were subdivided into more than 4 or 5 stages, as in a continuum, and that URICA-Hearing is a measure that can potentially be used to assess where the patients are in the course of their auditory rehabilitation process. In Experiment 2, an study with pre and post-intervention evaluation was performed in HA users. Subjects participated in 4 sessions of auditory rehabilitation and answered evaluative questionnaires at the beginning and at the end of the research. The results indicated that there were differences in the pre and post-intervention moments, in the Action/Maintenance factor as well as in the readiness to change of the studied sample. There was a significant correlation between the time of use of the HA in the post-intervention with the Action/Maintenance stage. All the sample of the present study had progression in the stages of change after the auditory rehabilitation. Despite the reduced sample, it was possible to perform a hearing rehabilitation study using the TTM precepts, however, it is necessary to carry out other studies aimed at establishing auditory rehabilitation counseling strategies for each stage of behavior change.

There has been inadequate attention to the aftercare of psychiatric patients, resulting in an increase in readmission rates plus longer hospital stays. There is a gap in the aftercare for psychiatric patients; The purpose of this qualitative retrospective study is to explore what may have contributed to readmission for psychiatric patients. The biopsychosocial model was used as the theoretical framework to support the direction of the research. The health belief model and transtheoretical model of change were used to further support for biopsychosocial model. The research questions were created to determine the influences on readmission, psychological well-being, explore the adaptation to aftercare and narrative of aftercare from the caregiver. This study used a content analysis to identify patterns and themes with a total of 10 participants. The data used had been previously collected by the behavioral transition team at Houston Methodist Hospital which consists of case notes, mental health diagnoses, hospital history and reasons for readmission. The findings include reports of psychiatric patients not adhering to their prescribed medication due to its side effects or cost, caregivers feeling overwhelmed, and the importance of psychoeducation. Once adjustments were made to the dosage or a prescription for less expensive medication, adherence improved, regular attendance to therapy sessions occurred, and the increase in the level of frustration from the caregiver. Psychiatric patients can benefit in post-discharge care if there is more focus on the reasons for hospital readmission by developing a treatment plan for the prevention of a relapse. This study may improve patient vulnerability to mental health issues and to assist psychiatric patients in establishing balance in their lives.

The aim of the present study was to examine the effects of the cinematherapy technique on the treatment of alcohol dependent patients. In terms of change, selfefficacy, decisional balance and motivation levels of participants were examined. 94 alcoholic patients from a state hospital, and 14 members of Alcoholics Anonymous&rsquo / Istanbul groups participated in the study. Participants were either inpatients in the dependence treatment center, or alcohol dependent patients who had been clean and sober for various periods of time. The cinematherapy technique was applied as an adjunct to alcohol dependence treatment. It included the presentation of a movie with an alcohol dependence theme followed by an elaboration session. Participants in the experimental group received two sessions of cinematherapy. On the other hand, control group A participants watched one movie unrelated with alcohol dependence. It was followed by an elaboration session with a non-alcoholic theme. Control group B participants watched two movies unrelated with alcohol dependence. Any elaboration session was not made with control group B participants. Decisional balance, self-efficacy, treatment motivation and stages of change were used as the main outcome measures in the pre-treatment and posttreatment assessments. Since the experimental and control groups sample sizes were small, non-parametric tests were used in data analysis. According to results, cons of alcohol and self-efficacy increased for the overall sample after cinematherapy sessions. In addition, the cinematherapy group showed higher identification than the control groups. Stages of change differences were gained for pros of alcohol use and self-efficacy in line with literature.

Advance Care Planning has been advocated for over 20 years as a way in which individuals who are no longer able to speak for themselves, may still convey their preferences regarding a wide of array of decisions, including medical care. Advance care planning may not be initiated by individuals for many reasons, and even when initiated, may not be specific enough to help guide decision making. Recent advance care planning models have utilized disease specific information to help guide end of life health care decision-making. Persons diagnosed with mild cognitive impairment face an increased possibility of developing dementia at some point in the future, but may retain decision making capability for a window of time, and thus the opportunity to participate in advance care planning. The advance care planning experiences of individuals with mild cognitive impairment have not been extensively studied. This study explored the advance care planning experiences of persons with mild cognitive impairment and their care partners' understanding and views of advance care planning, and if the diagnosis of mild cognitive impairment affects the advance care planning practices of these two groups. A convenience sample of 10 individuals with mild cognitive impairment and their 10 care partners (n=20) were recruited and interviewed. Using a grounded theory qualitative analysis approach, four themes were identified (1) decreased awareness regarding advance care planning from individuals with mild cognitive impairment versus a heightened awareness for the care partners; 2) the preference for comfort care measures only; 3) preferences for future end of life healthcare decisions largely influenced by previous end of life experiences with family and friends; and 4) lack of discussion of end of life healthcare decisions related to dementia and/or artificial nutrition and hydration by physicians or other healthcare providers. In addition two latent themes emerged including from the care partners, the importance of the mild cognitive impairment support group and lawyers for advance care planning and from both care partners and the mild cognitive impairment participants, trying to maintain autonomy, to `hang on' to self were identified. Study implications include the need for structured advance care planning interventions with individuals diagnosed with mild cognitive impairment to focus on common end of life scenarios, such as whether to use artificial nutrition and hydration, which will require future surrogate decision making.

Mental health professionals could be interested in finding how inappropriate behavior could be modified, especially when there are people that changes without treatment. This article explains how people change with a transteorical model of stages and processes. Psychological research shows that there are five stages in behavior modification: pre-contemplation, contemplation, preparation, action and maintenance. Besides, subjects have common processes in every stage. / Concita el interés de los profesionales de la salud mental el descubrir cómo se modifican los comportamientos desadaptativos, más aún existiendo gente que cambia sin tratamiento. Este artículo explica, a partir de un modelo transteórico de etapas y procesos, cómo cambia la gente. Las investigaciones, cada vez más, corroboran que en la modificación de los comportamientos existen 5 etapas: precontemplación, contemplación, preparación, acción y mantenimiento. Además los sujetos siguen procesos comunes en cada una de estas etapas.

Para que o indivíduo esteja engajado no uso do Aparelho de Amplificação Sonora Individual (AASI), é necessário que esteja motivado no seu processo de reabilitação e o profissional, tendo como ponto de partida a identificação do estágio motivacional do paciente, poderá apoiá-lo ao longo desse processo. Neste estudo foram realizados 2 experimentos distintos. O experimento 1 teve como objetivo caracterizar os perfis estabelecidos pela análise de clusters da Escala de Estágios de Mudança para Deficientes Auditivos (URICA-Audição), com base nos estágios motivacionais para a mudança em pacientes com deficiência auditiva. O experimento 2 teve como objetivo verificar se a URICA-Audição é sensível na identificação dos estágios de mudança em indivíduos submetidos à reabilitação auditiva. No experimento 1, foram analisados 200 protocolos preenchidos por indivíduos candidatos e usuários de AASI, com idade entre 24 e 94 anos, sendo 52 candidatos e 148 usuários de AASI há pelo menos um mês. Foi aplicada a URICA-Audição, composta por 25 itens divididos em cinco subescalas, com cinco itens cada: Pré-contemplação, Contemplação, Preparação, Ação e Manutenção. Para a análise dos resultados, foi realizada a Análise de Cluster Hierárquica por meio do método de centroides. Esta análise resultou em um total de 16 clusters distintos e, na solução encontrada, 167 sujeitos (83,5% da amostra) foram distribuídos em 8 clusters principais que continham mais de 10 participantes cada; 21 sujeitos (10,5% da amostra) se distribuíram em outros 3 clusters menores com 6 a 9 participantes; e 12 sujeitos (6% da amostra) se distribuíram em 5 clusters com 1 a 4 participantes cada. Dessa forma, verificou-se que os perfis dos pacientes subdividem-se em mais do que apenas 4 ou 5 estágios, como que em um continuum e, que a URICA-Audição é uma medida que pode, potencialmente, ser utilizada para avaliar onde os pacientes encontram-se no decorrer do seu processo de reabilitação auditiva. No experimento 2, foi realizado um estudo com avaliação pré e pósintervenção em usuários de AASI. Os participantes participaram em 4 sessões de reabilitação auditiva e responderam questionários avaliativos no início e no final da pesquisa. Os resultados indicaram que houve diferença nos momentos pré e pós-intervenção, no fator Ação/Manutenção da amostra estudada, assim como, na prontidão para a mudança do grupo. Houve correlação significante entre o tempo de uso do AASI na pós-intervenção com o estágio de Ação/Manutenção. Toda a amostra do presente estudo teve progressão nos estágios de mudança após a reabilitação auditiva. Apesar da amostra reduzida, foi possível realizar um estudo de reabilitação auditiva utilizando os preceitos do MTT, no entanto, é necessária a realização de outros estudos visando estabelecer estratégias de aconselhamento em reabilitação auditiva para cada estágio de mudança de comportamento. / In order for the individual to be engaged in the use of the Hearing Aid (HA), it is necessary that he is motivated in his rehabilitation process and starting with the identification of the patient\'s motivational stage the professional can support him throughout this process. There were performed two different experiments in this study. Experiment 1 aimed to characterize the profiles established by the clusters analysis of the Stages of Change for the Hearing Impaired Scale (URICA-Hearing) based on the motivational stages for change in patients with hearing impaired. Experiment 2 had as objective to verify if the URICA-Hearing is sensitive in the identification of the stages of change in individuals submitted to auditory rehabilitation. In the Experiment 1, two hundred protocols were filled out by candidates and users of HA, aged between 24 and 94 years, of which 52 were candidates and 148 were users of HA for at least one month. It was applied the URICA-Hearing that is composed of 25 items divided into five subscales, with five items each subscale: Pre-contemplation, Contemplation, Preparation, Action and Maintenance. For the analysis of the results, the Hierarchical Cluster Analysis was performed by means of the centroid method. This analysis resulted in a total of 16 distinct clusters and, in the solution found, 167 subjects (83.5% of the sample) were distributed in 8 main clusters that contained more than 10 participants each; 21 subjects (10.5% of the sample) were distributed in 3 other smaller clusters with 6 to 9 participants; and 12 subjects (6% of the sample) were distributed in 5 clusters with 1 to 4 participants each. Thus, it was verified that patients\' profiles were subdivided into more than 4 or 5 stages, as in a continuum, and that URICA-Hearing is a measure that can potentially be used to assess where the patients are in the course of their auditory rehabilitation process. In Experiment 2, an study with pre and post-intervention evaluation was performed in HA users. Subjects participated in 4 sessions of auditory rehabilitation and answered evaluative questionnaires at the beginning and at the end of the research. The results indicated that there were differences in the pre and post-intervention moments, in the Action/Maintenance factor as well as in the readiness to change of the studied sample. There was a significant correlation between the time of use of the HA in the post-intervention with the Action/Maintenance stage. All the sample of the present study had progression in the stages of change after the auditory rehabilitation. Despite the reduced sample, it was possible to perform a hearing rehabilitation study using the TTM precepts, however, it is necessary to carry out other studies aimed at establishing auditory rehabilitation counseling strategies for each stage of behavior change.

Today, organizations are facing rising costs caused by increased employee sick - leave. A way to motivate employees to choose a healthier lifestyle is for the employer to offer wellness incentives. However, not too many employees are taking advantage of the incentives. According to the Transtheoretical Model of Health Behavior Change (TTM) , people are at different stages in their behavior change process. By knowing their personal obstacles to change, organizations can use nudge management and wellness incentives to help their employees to choose a healthier lifestyle. In order to get some answers, we conducted qualitative interviews at the Swedish Migration Agency. The result of our research showed seven main obstacles, and in this thesis we have explored dif erent nudges organizations can use to promote health and to lower sick - leave.

Abstract The aim of this study was to describe the characteristic features of weight management and lifestyle changes of people of working age at risk of type 2 diabetes. Seventy-four persons at high risk of type 2 diabetes, 33 men and 41 women, took part in the study. They attended group counselling sessions led by a dietician either at distance or face-to-face. There were 5 distance groups, with the counselling given by a dietician via a videoconferencing link to participants who met in the meeting room of their local health care centre. There were 6 personal groups where the dietician and the group participants met face-to-face at the same location. Each group had 5 to 9 participants. The following were used as study material: videotaped group discussions on the benefits and barriers of lifestyle changes at the beginning of the counselling process, weight management at the beginning and at the end of the process, and weight management and the preconditions and risk factors of successful weight management at the follow-up visit 1.5 years after the end of the process. In addition, study data were gathered before the first and last interventions and before the follow-up visit with a questionnaire sent to the subjects. The subjects were weighed at the beginning and at the end of the counselling process as well as at the follow-up visit. The video material was analysed using both inductive and deductive content analysis. The data were analysed also using SPSS 16.0 software for Windows. At the beginning of the counselling process, 68%, 9% and 14% of the subjects were at the contemplation, preparation and action stages, respectively, the corresponding percentages at the end of the counselling process being 24%, 33% and 40%. Forty subjects had made progress in their lifestyle change stage, 18 had remained where they had been, while 5 had regressed. One and a half year after the end of the counselling process, about half of the subjects were at the maintenance phase in terms of various lifestyle factors (restricting the amount of food, eating regular meals, increasing the intake of nutritional fibre, unsaturated fat and physical activity, restricting alcohol intake). Twenty-one subjects reported relapses, most often in terms of restricting the amount of food intake. Improved health and functional ability were seen as the benefit of lifestyle change. A change in lifestyle calls for effort and resources. The preconditions of successful weight management were one.s own actions, motivation and resources. Weight management was made more difficult by lack of commitment to one’s own actions and lack of goals, self-discipline and motivation. The information obtained with the study may be utilised in developing interventions aimed at persons at risk of type 2 diabetes as well as their contents and methods. The results can also be made use of in improving the counselling skills of health-care students and professionals. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata tyypin 2 diabeteksen riskiryhmään kuuluvien työikäisten henkilöiden painonhallinnan ja elintapamuutoksen tunnuspiirteitä. Tutkimukseen osallistui 74 työikäistä tyypin 2 diabeteksen korkean riskin henkilöä. Tutkittavista 33 oli miehiä ja 41 naisia He osallistuivat ravitsemusterapeutin ryhmäohjaukseen joko etä- tai lähiryhmässä. Etäryhmiä oli 5. Niissä ohjaus toteutui siten, että ohjaaja oli videoneuvottelulaitteiden avulla yhteydessä ryhmäläisiin, jotka olivat kokoontuneet oman kuntansa terveyskeskuksen kokoustilaan. Lähiryhmiä oli 6. Niissä ohjaus toteutettiin siten, että ohjaaja ja ryhmäläiset olivat samassa tilassa. Kussakin ryhmässä oli 5–9 osallistujaa. Tutkimusaineistona käytettiin videoituja keskusteluaineistoja, joissa ryhmään osallistuneet kuvasivat elintapamuutoksen hyötyjä ja haittoja ohjausprosessin alussa, painonhallintatilannettaan ohjausprosessin alussa, lopussa ja seurantakäynnillä sekä painonhallinnan onnistumisen edellytyksiä ja riskitekijöistä seurantakäynnillä 1,5 vuotta ohjausprosessin päättymisen jälkeen. Lisäksi tutkimusaineistoa kerättiin ennen ensimmäistä ja viimeistä ohjauskertaa sekä ennen seurantakäyntiä tutkittaville lähetetyllä kyselyllä. Paino mitattiin ohjausprosessin alussa, lopussa ja seurantakäynnillä. Videoaineisto analysoitiin sekä induktiivisella että deduktiivisella sisällönanalyysilla. Aineiston analysoinnissa käytettiin myös SPSS 16.0 for Windows -ohjelmaa. Ohjausprosessin alussa tutkittavista 68 % oli harkintavaiheessa, 9 % valmistautumis- ja 14 % toimintavaiheessa ja ohjausprosessin lopussa 24 % oli harkinta-, 33 % valmistautumis- ja 40 % toimintavaiheessa. Tutkittavista 40 edistyi elintapamuutosvaiheessaan, 18 pysyi ennallaan ja 5 taantui. Puolentoista vuoden kuluttua ohjausprosessin päättymisestä noin puolet tutkittavista oli ylläpitovaiheessa jonkun elintavan suhteen (kuidun ja rasvan käyttö, ruokamäärä, ateriarytmi, liikunta, alkoholin käyttö). Repsahduksista raportoi 21 henkilöä. Niitä oli tapahtunut eniten ruokamäärän rajoittamisen suhteen. Elintapamuutoksen hyötynä nähtiin terveyden ja toimintakyvyn paraneminen. Elintapamuutos vaatii vaivannäköä ja voimavaroja. Painonhallinnan onnistumisen edellytyksiä olivat oma toiminta, motivaatio ja voimavarat. Sitoutumattomuus omaan toimintaan, tavoitteiden, itsekurin ja motivaation puute vaikeuttivat painonhallintaa. Tutkimuksen avulla saatua tietoa voidaan käyttää kehitettäessä tyypin 2 diabeteksen riskiryhmiin kuuluvien henkilöiden ohjauksen sisältöä ja menetelmiä. Tuloksia voidaan hyödyntää myös terveydenhuollon opiskelijoiden ja ammattihenkilöiden ohjaustaitojen kehittämisessä.