Obesity affects over 100 million men, women, and children in North America alone and has reached what health professionals deem to be epidemic proportions. Being overweight can contribute to or cause chronic conditions such as diabetes, cardiovascular disease and cancer. Left unabated, it will lead to the premature death of millions. Clinical practice relies primarily on individual interventions to bring about lifestyle change. However, this may not be sufficient to reverse the trend on a population scale. Distance education is one area that is seen by some as one of the tools that is capable of reaching such a large audience. This mixed methods case study examined the perceived utility of a number of distance education tools and technologies and the likelihood of overweight and obese individuals adopting and using them. A number of distance education tools and technologies were found to be very useful, some that could be promising but will require further study, and still others that don't offer value and won't for the foreseeable future. / August 2011

In order to assist people in making positive changes of problematic behaviour it is necessary to examine how people change and what factors influence the process. Criminal offenders represent a group of individuals who often have difficulty desisting from problematic behaviour and continue to engage in illegal activity. Offenders in provincial correctional institutions were administered questionnaires to determine stage of change and processes utilized as outlined in the Transtheoretical Model (TTM) of change (Prochaska & DiClemente, 1984). Additionally, offenders were asked about their visions of the future using the Possible Selves (PSs) Model (Markus & Nurius, 1986). Taken together, this study looked at the contribution of the PSs Model to our understanding of the TTM, which has been criticized in recent years as lacking therapeutic significance for treatment providers as they guide individuals through the change process. More specifically, this study compares chronic criminals with first time offenders on psychological variables such as readiness for change, vision of possible selves, and hope for the future, as well as on legal variables such as risk for recidivism and institutional behaviour. The results indicate that most offenders acknowledged their behaviour as problematic and some even reported they were actively taking steps to change; however, chronic offenders admitted having less hope than first time offenders. Interestingly, both groups rated similarly on the dimensions of PSs. The outcomes would suggest that research efforts to incorporate other complimentary theories of change into the TTM, like the PSs model, may be helpful for understanding the process of change. While it seems these models may not be useful for predicting institutional behaviour, the data perhaps demonstrates the complexity of criminal behaviour and speaks to the necessity of further research in this population.

Overweight and obese women who lose weight prior to pregnancy have fewer pregnancy complications than those who do not (Forsum, Brantsaeter, Olafsdottir, Olsen, & Thorsdottir, 2013; Schummers, Hutcheon, Bodnar, Lieverman, & Himes, 2015). Research findings suggest there are missed opportunities to provide diet and physical activity counseling during preventive care visits. Providers cite a lack of time and resources as barriers (Morgan et al., 2006; Yamamoto et al., 2014). This was a two-group, randomized, pilot-study of 19 overweight or obese women in Central Georgia. Participants completed surveys related to their perception of risk for obesity-related pregnancy complications, readiness to change nutrition and physical activity behaviors, nutrition and physical activity self-efficacy, actual physical activity, and dietary history at baseline, after completion of the study, and at follow-up. Those in the intervention group participated in one face-to-face meeting, reviewed eight online education modules, and received weekly booster messages. The control group participated in a similar protocol; however, information was limited to general women’s health topics. Nineteen women (intervention = 11, control = 8) completed all instruments related to primary outcomes—perception of risk, readiness to change, and self-efficacy. The average age of participants was 28.7 years (SD = 6.35). The average body mass index was 36.54 kg/m2 (SD = 5.52). Women were predominately Caucasian (68.4%) and married (52.6%) with children (57.9%). Most had a college degree (42.1%) or higher (15.8%), and a yearly income between $25,000 and $75,000 (42.1%). Evaluation of completion data, resources, and intervention management indicated that the intervention may be feasible during preventative care visits. Participant responses to exit interview questions demonstrated the intervention may be acceptable for women of childbearing age. Effect sizes ranged from small (ƞp2= .00, p = .88) to large (ƞp2= .27, p = .08) indicating the intervention may be effective in an adequately powered sample. Future research should focus on the further development and implementation of programs that assist with pre-conception weight loss. Providing women with information regarding the complications associated with being overweight and obese, as well as the information or tools necessary to reduce weight prior to pregnancy, may be instrumental for improving short and long-term pregnancy outcomes for both mothers and their offspring.

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Syftet med denna studie är att undersöka hur individer tagit sig ut ett drogmissbruk och hur de håller sig nyktra. För att uppnå detta har det genomförts kvalitativa intervjuer med personer som själva identifierar sig som nyktra narkomaner. Den insamlade empirin har analyserats med hjälp av den transteoretiska modellen som utgår ifrån att förändring sker stegvis och genom processer. Resultatet visar att individen upplever negativa konsekvenser av droganvändningen och ofta når en personlig botten innan hen bestämmer sig för att sluta. Förändringsprocessen sker bland annat genom att individen får ett andligt uppvaknande. För att kunna bibehålla nykterheten visar studien att relationen till Gud och anhöriga är viktig. Att hitta en ny mening i livet där man hjälper andra människor är också av stor betydelse. / This study examines how individuals have emerged out of substance abuse and how they stay sober. To achieve this we have done qualitative interviews with sober drug addicts. The collected empirical data has been analyzed using the Transtheoretical Model (TTM) that assumes that change occurs gradually and through processes. The result shows that the individual experience negative consequences of the drug abuse and often reaches a personal rock bottom before he or she choose to terminate.  The process of change partly occurs through a spiritual awakening. To maintain the sobriety our study also shows that the relationship to God and relatives are important. Finding a new purpose in life where you help other people is also significant.

Clinical research suggests that adolescent offenders often do not view their criminal behaviors as problematic and, therefore, are not motivated for treatment. Although customarily defined as a static characteristic, the transtheoretical model (TTM) proposes treatment amenability is dynamic and can be achieved through tailored interventions that motivate individuals for treatment. The current study examines the predictive validity of TTM measures for adolescent offenders at a maximum security correctional facility. In particular, the Stages of Change Scale (SOCS) and Decisional Balance for Adolescent Offenders (DBS-AO) were compared with a more traditional assessment tool utilized in evaluating treatment amenability of juvenile offenders (i.e., Risk-Sophistication-Treatment Inventory; RSTI). One hundred adolescent offenders from the Gainesville State School completed two waves of data collection with a 3-month time interval. Information was collected on offenders' treatment progress between waves. Consistent with TTM research, predictors of treatment progress included low scores on the Cons scale on the DBS-AO and on the Precontemplation scale on the SOCS. Participants in the most advanced levels of treatment also scored high on the Sophistication-Maturity scale on the RSTI and the Impression Management scale on the Paulhus Deception Scale.

Regular physical activity is associated with improved physiological and psychological wellbeing, by reducing the risk of chronic illnesses such as cardiovascular disease, cancer, obesity, diabetes, osteoporosis and depression. There is a common perception that physical activity levels in the population are declining, and one of the biggest changes affecting this is occupational based activity. Since adults spend on average over 50% of their waking hours at work, work sites have the potential to be an important setting for health promotion initiatives. Cognitions and behaviours are key causal factors behind many of today s most widespread health problems and illnesses. The stage of change model has been highlighted as having intuitive appeal because it considers the dynamic nature of attitudes and behaviour change. This thesis is concerned with the application of the stage of change model to an occupational health intervention promoting physical activity. Several research studies were undertaken to explore the experiences of employees with workplace health initiatives and investigate the strategies and practices used by occupational health to promote healthy behaviours. These research studies highlighted the barriers and facilitators to successful health interventions and contributed towards the design, development and implementation of an activity promotion intervention. Additional research was also conducted to develop information materials based on the stage of change model. The stage approach was simplified and intervention materials were classified based on whether employees were thinking about making a change or not thinking about making a change to their activity levels. In order to test the materials, a twelve month intervention was implemented in ten work sites across the UK that were allocated to one of three groups. Two groups received information materials and one group received no information during the intervention period (control group). The difference between the two groups who received information was that one group received standard activity promotion information (standard group) and the second group received tailored information based on their stage of change construct (staged group). Participants in the staged intervention group demonstrated significant decreases in body mass index, fat percentage, waist circumference, blood pressure and resting heart rate following the twelve month intervention. In contrast, reductions were identified for the standard intervention group for waist circumference and diastolic blood pressure. Finally, there were no long-term significant improvements identified for the control group. However, group comparisons revealed there were no significant differences between the intervention conditions. The intervention also recorded self-reported psychological outcomes, which demonstrated variations throughout the intervention period for all groups. The potential reasons for these inconsistent outcomes are discussed. A process evaluation following the intervention demonstrated employees valued the health screenings and identified issues relating to knowledge, behaviour change and health implications that were important outputs of the intervention. Based on these findings, the research concludes there is scope to make physical activity interventions in the workplace more effective by applying the stage of change approach. Using the process of simplifying the stages and focusing on whether employees want to change their behaviours or not allows occupational health to deliver information that could be more meaningful and have a significant impact on behaviour change. By understanding employees readiness to change their activity behaviours and targeting information based on their beliefs, attitudes and intentions to change may produce significant improvements in health outcome measures compared to standard information. The results also suggest there is potential for this type of tailored intervention to be extended to other occupational health issues.

Demoralization is a concept that evolved out of the study of individuals under stress. It is defined as the combination of distress and subjective incompetence in the presence of inadequate social bonds. When patients with alcohol abuse problems are diagnosed with cancer they may become demoralized and be unable to summons adequate resources to address issues associated with changing their addictive behavior. The Stage of Change Model (SOC), one of the primary approaches in addiction therapy, is used to guide individuals through the process of behavioral change. This two phase study examined the relationship between demoralization and stage of change. The fist phase was a retrospective chart review (N =112) intended to establish the psychometrics of a new instrument measuring the subjective incompetence component of demoralization. The twelve item Subjective Incompetence Scale (SIS) demonstrated strong internal consistency (.92) and strong indices of being a reliable and valid measure. As expected there was a weak relationship in a positive direction with pain and confusion, a moderate and positive relationship with avoidant coping, and a strong and positive relationship depression, anger and fatigue. There was a moderate and negative correlation with apathy which was also in the direction expected. Phase two was a correlational study using a survey research design, aimed at examining the relationship between alcohol use, depression, level of demoralization and stage of change. The study was done on a convenience sample of patients in colorectal and gastrointestinal clinics at H. Lee Moffitt Cancer Center (N=71). Depression and demoralization were found to be distinct but related constructs. Level of alcohol consumption was not correlated with SOC. The components of demoralization were regressed on Stage of Change to determine their predictive value. Social support (ISELSF), perceived stress (IES) and subjective incompetence (SIS) resulted in a significant increment in variance explained ( R2 ). The whole model produced R2 =.284, F (7, 53) = 2.847, p =.013 which explained a significant portion of the variance in stage of change. Implications for practice and directions for future research are discussed.