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.

The purpose of this study was to investigate how some elected established coaching models works in practice, and how the respondents perceived the situation of having a coach. There were three participants in the study, two men and one woman.   The first part of the study was to investigate how some established coaching models work in practice, which was inspired by action research. The coaching process was grounded in Höigard and Jörgensens (2002) four-stage model, while the transtheoretical model was used as a complement to describe and analyze the participants incline to change. Both of these models emphasize the weight of using a good goal setting strategy and the SMART-model (Faskunger, 2002) was used to meet this. The data collection was performed on qualitative grounds when notes of the coaching interviews were taken to notice the participants willingness to change. This could for example be something that the participants had sad or something they’ve done to move between the different stages according to the transtheoretical model. The second part of the study was to investigate how the participants experienced the situation of having contact with a coach. This part was executed on qualitative grounds were an interview met the purpose.   The result indicated that the coaching process might have influenced the participants motivation to change their behavior. This was presumed to depend on the techniques and methods that had been used (i.e., target strategies, empowerment and the confidence shown from the coach). Initially it was shown that the participants motivation to change seems to be extrinsic. During the process the motivation factors changed and the participants seems to have acquired a motivation of a more internal character. This because the participants after some time described that they changed their behavior for their own sake. According to the transtheoretical model the participants advanced from the preparation stage to the action stage, with hope to reach all the way to the activity stage. / Syftet med studien var att undersöka hur några utvalda etablerade coachingmodeller fungerar i praktiken, samt hur respondenterna upplevde situationen att ha haft kontakt med en coach. Tre respondenter deltog i studien, varav två män och en kvinna.   Första delen av syftet var att undersöka hur några utvalda etablerade coachingmodeller fungerar i praktiken, vilket var inspirerat av aktionsforskning. Coachingprocessen tog sin grund i Høigaard och Jørgensens (2002) fyrastegsmodell, medan den transteoretiska modellen användes som ett komplement för att beskriva och analysera respondenternas förändringsbenägenhet. Båda dessa modeller betonar vikten av att använda sig av en god målsättningsstrategi och SMART- modellen (Faskunger, 2002) användes för att tillgodose detta. Datainsamlingen skedde på kvalitativa grunder då anteckningar av coachingsamtalen togs för att notera respondenternas förändringsbenägenhet. Detta kunde exempelvis vara något som respondenterna sagt eller något som respondenterna gjort för att förflytta sig mellan de olika stadierna enligt den transteoretiska modellen. Den andra delen av syftet var att ta reda på hur respondenterna upplevt situationen av att ha haft kontakt med en coach. Även denna del genomfördes på kvalitativa grunder där en intervju tillgodosåg syftet.   Resultatet visar att coachingprocessen tycks ha haft en inverkan på respondenternas motivation till att förändra sitt beteende. Detta antas bero på de tekniker och metoder som har använts, exempelvis målsättningsstrategier, självbestämmande samt en upplevd trygghet från coachen. Till en början visade det sig att respondenternas motivation till förändring tycktes bestå av yttre karaktär. Allt efter processens gång förändrades motivationsfaktorn och respondenterna verkar ha skaffat sig en motivation av mer inre karaktär. Detta eftersom respondenterna efter en tid beskrev att de förändrade sitt beteende för sin egen skull. Enligt den transteoretiska modellen avancerade respondenterna från förberedelsestadiet till handlingsstadiet, med en förhoppning om att nå hela vägen fram till aktivitetsstadiet.

The future of Vermont’s 1.8 million hectares (4.5 million acres) of forest habitat will be largely determined by the decisions of family forest owners, who collectively own 60% of the state’s forested land. To promote management for wildlife habitat, government agencies and non-governmental partnerships provide technical and financial support to family forest owners in the form of conservation assistance programs. In Chapter 1, I qualitatively compared the efficacy of two types of conservation assistance programs available in Vermont: traditional programs offered through the Natural Resources Conservation Service, and a simplified, accelerated program offered through a non-governmental partnership called Woods, Wildlife, and Warblers. By conducting interviews with 20 Vermont family forest owners, I identified common motivation and barrier themes and compared these themes across programs using the Transtheoretical Model’s Stages of Change. Most motivations and barriers were described by landowners across all Stages of Change, but two motivations (professional recommendations and straightforward applications) and one barrier (independent forest management values) varied by either Stage of Change, program type, or both. I used the findings from the interviews to develop a mail survey, which was used to quantify patterns regarding motivations and barriers towards three habitat conservation actions: 1) arranging for a forestry professional to walk the land, 2) applying for cost-share funds, and 3) making a patch cut. The results from this survey, which was sent to 2,122 randomly selected Vermont family forest owners and had a cooperation rate of 38%, are presented in Chapter 2. Using logistic regression models, I identified multiple significant motivations or barriers for each of the three actions. Additionally, I used contingency tables to compare respondents’ levels of agreement for these motivations and barriers – as well as their level of trust for various information sources – with their Stage of Change. Overall, levels of agreement varied significantly across one or more Stages of Change for all motivations and barriers, and trustworthiness varied for 13 out of 14 information sources. Across both chapters, I provide recommendations to increase program efficacy with an emphasis on program attributes and tailored messaging.

Studiens inledning ger en övergripande bild av problemområdet och de konsekvenser som medföljer vid fysisk inaktivitet. Depression, övervikt, fetma, typ 2-diabetes och hjärt- kärlsjukdomar är några av de välfärdssjukdomar som individen kan drabbas av. Detta kostar samhället mycket pengar, tid och resurser. Problemet kan motverkas med hjälp av metoden Fysisk aktivitet på recept (FaR) som är en väletablerad metod, men som behöver utvecklas och användas mer konsekvent. Vår studie utgår från sjukvården och friskvården som hälsofrämjande arena. Syftet med studien är att undersöka hur samarbetet mellan hälso- och sjukvården och friskvården fungerar vid förskrivning av Fysisk aktivitet på Recept, samt beskriva förskrivares upplevelser av att ordinera FaR i Skåne. För att kunna besvara studiens syfte valdes en kvalitativ metod i form av semistrukturerade intervjuer med tre stycken förskrivare samt två aktivitetsarrangörer. För att analysera det insamlade materialet använde författarna sig av kvalitativ innehållsanalys. Det övergripande resultatet visade att det finns brister i samarbetet mellan sjukvården och friskvården vid ordinering och uppföljning av fysisk aktivitet på recept. Resultatet visar även att det är viktigt att förskrivaren förhåller sig till patientens motivationsgrad och anpassar receptet utifrån det beteendeförändringsstadiet patienten befinner sig i. Teorin som har använts för att analysera resultatet i diskussionen är den transteoretiska modellen. Slutsatsen som drogs utifrån studiens resultat var att: samarbetet mellan förskrivare och aktivitetsarrangörer i dagsläget inte fungerar och att det behövs tydligare riktlinjer från varje enskild region och kommun för uppföljning och samverkan mellan förskrivare och aktivitetsarrangörer. / The introduction of this study gives an overall review of the problem area and the consequences that come with physical inactivity. Depression, obesity, type 2 diabetes and cardiovascular disease are some of the welfare disorders that physical inactivity can lead to. This costs society a lot of money, time and resources. The problem can be countered by the method Physical Activity on Prescription (FaR). Our study is based on healthcare and wellness as a health promotion arena. The aim of this study is to investigate how the collaboration between healthcare and wellness workers is functioning when prescribing physical activity on perception, as well as a description of prescribers experiences when organizing FaR in Skåne. In order to answer the purpose of the study, a qualitative method was chosen in the form of semi-structured interviews with three prescribers and two activity organizers. Qualitative content analysis was used when analyzing the material. The overall result showed that collaboration between healthcare and wellness workers is scarce when ordering and following up physical activity on prescription. The result also shows that it is important that the prescriber adheres to the patient's degree of motivation and adapts the prescription based on the behavioral change stage the patient is in. The theory that has been used to analyze the result in discussion is the transtheoretical model. The conclusion drawn from the study result was that there is a lack of collaboration between prescribers and activity organizers and each region needs to implement more direct guidelines concerning patient follow-up and collaboration between prescribers and activity organizers.

Introduction: Over 80% of the world’s one billion tobacco smokers reside in low- and middle-income countries (LMICs); therefore, it is important to understand factors that promote intention to quit smoking in these countries. This study evaluated factors associated with three stages of intention to quit tobacco smoking among adults in LMICs. Methods: Data from 43,540 participants of the Global Adult Tobacco Survey in 14 LMICs were analyzed. Intentions to quit smoking were categorized into precontemplation (referent category), contemplation, and preparation stages based on the transtheoretical model. A multinomial logit model was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: Approximately 82%, 14%, and 4% of the smokers were in precontemplation, contemplation, and preparation stages, respectively. Rural residents had increased odds of being in contemplation stage (OR = 1.41, 95% CI = 1.09–1.83) compared to urban residents. Compared to homes where smoking was allowed, smoke-free homes were associated with increased odds of contemplation (OR = 1.77, 95% CI = 1.41–2.23) and preparation (OR = 2.18, 95% CI = 1.78–2.66). Exposure to anti-smoking messages in more than one media channel was associated with increased odds of contemplation (OR = 1.60, 95% CI = 1.33–1.92) and preparation (OR = 1.73, 95% CI = 1.28–2.33) compared to no exposure to anti-smoking messages. Conclusion: The results suggest that anti-smoking media campaigns and smoke-free policies may promote intention to quit smoking in LMICs. While these suggest the need for implementation of comprehensive anti-smoking campaigns and smoke-free policies, longitudinal studies are required to confirm these findings and to evaluate how intention to quit translates into quit attempts in LMICs.

The current study evaluated the initial feasibility, efficacy, and acceptability of a motivationally-tailored family-based intervention designed to promote the adoption of healthy lifestyle behaviors associated with physical activity and nutrition. Parents (N=132) of children 6 to 11 years old were randomly assigned to the intervention or control condition, and they completed a series of online questionnaires. Intervention participants (n=61) received a single motivationally-tailored feedback report via e-mail. Control participants (n=71) completed measures and immediately received information about a free online resource that provides information about healthy lifestyle behaviors (www.mypyramid.gov). Feasibility data indicate that an online feedback program has high dissemination potential (parents from 31 states participated). However, the current methodology is not sufficient in reaching families who are at greatest risk for developing chronic health conditions associated with obesity or low activity level. In general, the intervention was acceptable to parents. Outcome data revealed that the intervention and control groups did not differ significantly on most variables at one month follow-up. Exploratory analyses provided additional evidence for the importance of including parents and targeting parent-child interactions in the context of pediatric nutrition and physical activity interventions. Limitations and future directions are discussed.