Attitude, social influence, and self-efficacy among Chinese participants of chronic disease self-management program: A latent growth curve modeling study.

Objectives: This study aimed to examine temporal relationships among psychological parameters (readiness to change, changes in self-efficacy [SE], social norm [SN], attitude [AT]) and two self-management behaviors: cognitive symptom management (CSM) and tangible help-seeking (TH) by constructing latent growth change models. Method: This was a longitudinal study of 60 Chinese participants with various chronic diseases who completed a 6-week chronic disease self-management program. Psychological and behavioral variables were assessed at the beginning of the 1st, 4th, and 6th week of the program. Results: Latent growth change curve analysis revealed that, in the early stages of engagement in CSM, SE was a key determinant of behavior. During the 6-week period, changes in SE were influenced directly by both SN and AT. When engaging in TH, SE influenced the behavior with direct and indirect effect from AT and SN. Readiness for change, on the other hand, appeared to be more associated with psychological rather than behavioral changes. This study revealed different underlying change mechanisms for two types of self-management behaviors. Conclusion: The findings shed light on program modifications that could further strengthen the therapeutic effects of the program. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The Predictive Validity of the University of Rhode Island Change Assessment Questionnaire in a Heroin-Addicted Polysubstance Abuse Sample.

The purpose of this investigation was to examine the predictive utility of the stages-of-change scales of the University of Rhode Island Change Assessment (URICA; E. A. McConnaughy, J. O. Prochaska, & W. F. Velicer, 1983) questionnaire in a heroin-addicted polysubstance-abusing treatment sample. Ninety-six participants completed the URICA at the beginning of a 29-week treatment period that required thrice-weekly urine drug screens. Multivariate multiple regression analysis indicated that after controlling for demographic variables, substance abuse severity, and treatment assignment, the stages-of- change scales added significant variance to the prediction of heroin- and cocaine-free urine samples. The Maintenance scale was positively related to cocaine-free urines and length in treatment. The implications of these findings for treatment and for measuring readiness among individuals using multiple substances while taking maintenance medications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of the University of Rhode Island Change Assessment to measure motivational readiness to change in psychiatric and dually diagnosed individuals.

In this report, the original 4-factor structure of the University of Rhode Island Change Assessment (URICA; C. C. DiClemente & S. O. Hughes, 1990) was replicated, and the scale's internal consistency was found to be acceptable in a sample of 120 psychiatric and dually diagnosed inpatient participants, who had participated in a randomized clinical trial comparing standard treatment (ST) and ST plus motivational interviewing. Contrary to the authors' hypotheses, participants classified as having low motivational readiness to change, based on their URICA scores, demonstrated greater treatment adherence than high-readiness participants, in that they attended a greater proportion of therapy groups while hospitalized (54% vs. 39%; p     

Readiness to adopt a self-management approach to cardiac health: Predicting outcomes from cardiac rehabilitation.

Purpose/Objective: To examine whether initial attitudes toward a self-management approach to cardiac health and early-treatment changes in those attitudes predict outcomes in cardiac rehabilitation. Research Method/Design: One hundred eighteen participants took part in a 12-week Phase II cardiac rehabilitation program. Questionnaires to assess readiness to engage in a self-management approach, mood, activity level, and diet were completed at pretreatment and at Weeks 3, 6, 9, and 12. Results: Repeated-measures regressions showed that participants with higher pretreatment levels of readiness to engage in a self-management approach showed more pronounced improvements in mood, activity level, and diet than did those with lower levels of readiness. Those who reported significant shifts in self-management attitudes during the first 3 weeks of the program finished treatment with greater improvements on measures of mood, cardiorespiratory fitness, activity level, and weight than did participants who reported smaller shifts. Conclusions/Implications: Results suggest that pretreatment acceptance of a self-management orientation, as well as early shifts toward such a stance, predicted treatment gains. This information may be used to improve outcomes from cardiac rehabilitation by intervening to enhance readiness in those that start at low levels or fail to engage in the initial stages of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stages of change in methadone maintenance: Assessing the convergent validity of two measures.

This study compared 2 alternate measures of stage of change as conceived by J. O. Prochaska and C. C. DiClemente (see record 1983-26480-001). A sample of 276 methadone maintenance patients completed both categorical and dimensional measures of stage of change regarding quitting illicit drug use. The categorical measure places participants into 1 of 5 stages based on their stated intentions regarding future illicit drug use. The University of Rhode Island Change Assessment scale (URICA) provides continuous scores on 4 stage-of-change scales. Confirmatory factor analysis was used to assess the URICA's factor structure. The relationship between URICA scores and self-reported drug use was also assessed. Comparison of the URICA and the categorical measure using discriminant function analysis indicated limited convergence between the 2 measures and suggests that they may assess different aspects of readiness to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stages of Change in Treatment-Seeking Pathological Gamblers.

The transtheoretical model has been applied to many addictive disorders. In this study, psychometrics properties of the University of Rhode Island Change Assessment (URICA) scale were evaluated in 234 pathological gamblers initiating treatment. Four components were identified--reflective of precontemplation, contemplation, action, and maintenance stages--with internal consistency from .74 to .88. Cluster analyses identified 4 patterns of responding, ranging from ambivalent to active change. The 4 clusters differed with respect to baseline gambling variables and treatment engagement and outcomes assessed 2 months later. A continuous measure of readiness to change was also correlated with gambling severity and predictive of reductions in gambling. This study provides initial support for reliability and validity of the URICA in treatment-seeking gamblers, and it suggests that stage of change may have an impact on outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational subtypes and continuous measures of readiness for change: Concurrent and predictive validity.

This study compared the concurrent and predictive validity of motivational subtypes versus a continuous measure of readiness for change as measured by the University of Rhode Island Change Assessment Scale (URICA; E. A. McConnaughy, J. O. Prochaska. & W. F. Velicer, 1983) in 252 individuals participating in a substance abuse treatment study (38% female; mean age = 36). Hierarchical cluster analysis identified a 2-cluster solution. Consistent with previous research, both the motivational subtypes and the continuous readiness measure exhibited good concurrent validity with both baseline characteristics and change process variables. Neither readiness-for-change measure predicted end treatment outcomes. Measures of readiness for change based on the URICA exhibit limited clinical utility, because they are not able to predict future behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing disability and managing chronic illness in frail older adults: a randomized trial of a community-based partnership with primary care

BACKGROUND: Effective new strategies that complement primary care are needed to reduce disability risks and improve self-management of chronic illness in frail older people living in the community. OBJECTIVE: To evaluate the impact of a 1-year, senior center-based chronic illness self-management and disability prevention program on health, functioning, and healthcare utilization in frail older adults. DESIGN: A randomized controlled trial. SETTING: A large senior center located in a northeast Seattle suburb. The trial was conducted in collaboration with primary care providers of two large managed care organizations. PARTICIPANTS: A total of 201 chronically ill older adults seniors aged 70 and older recruited through medical practices. INTERVENTION: A targeted, multi-component disability prevention and disease self-management program led by a geriatric nurse practitioner (GNP). MEASUREMENTS: Self-reported Physical function, physical performance tests, health care utilization, and health behaviors. RESULTS: Each of 101 intervention participants met with the GNP from 1 to 8 times (median = 3) during the study year. The intervention group showed less decline in function, as measured by disability days and lower scores on the Health Assessment Questionnaire. Other measures of function, including the SF-36 and a battery of physical performance tests, did not change with the intervention. The number of hospitalized participants increased by 69% among the controls and decreased by 38% in the intervention group (P = .083). The total number of inpatient hospital days during the study year was significantly less in the intervention group compared with controls (total days = 33 vs 116, P = .049). The intervention led to significantly higher levels of physical activity and senior center participation and significant reductions in the use of psychoactive medications. CONCLUSIONS: This project provides evidence that a community-based collaboration with primary care providers can improve function and reduce inpatient utilization in chronically ill older adults. Linking organized medical care with complementary community-based interventions may be a promising direction for research and practice.     

Prevention of Heavy Drinking and Associated Negative Consequences Among Mandated and Voluntary College Students.

The Lifestyle Management Class (LMC) was evaluated as a universal and targeted alcohol prevention program among voluntary and mandated college students. The relative efficacy of peer- and professional-led group interventions was also tested in this randomized, controlled design. LMC participants showed decreases in driving after drinking relative to control participants. Changes in heavy drinking varied as a function of treatment condition, readiness to change, and gender, with a trend toward larger decreases among voluntary LMC participants high in readiness to change and a comparable though nonsignificant advantage for male LMC participants in the mandated sample. The LMC was comparably effective for mandated and voluntary students, with no clear advantage for peer- or professional-led groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotic discontinuation in chronic insomnia: Impact of psychological distress, readiness to change, and self-efficacy.

Objective: To compare individuals who were successful in discontinuing hypnotic medications against those who were not on measures of insomnia severity, medication withdrawal symptoms, psychological symptoms, perceived health, readiness to change and self-efficacy. Design: Secondary analyses of a randomized clinical trial comparing a hypnotic taper intervention with or without self-help treatment for insomnia. Main Outcome Measures: Self-report measures of insomnia severity, medication withdrawal symptoms, depression and anxiety symptoms, physical and mental health, stages of change, readiness to change, decisional balance, and general and situational self-efficacy. Results: There were no significant differences at baseline between medication-free individuals and those still using sleep medication at the end of a taper intervention. Group differences emerged midway through the 8-week withdrawal program and were accentuated after the intervention; participants who remained medication-free during the next six months had less severe insomnia and anxiety symptoms, a more positive perception of their health and higher self-efficacy to refrain from hypnotic use in various situations. Contrary to expectations, there were no differences between drug-free and nondrug-free participants on both readiness to change and stages of change. Conclusions: Chronic users of hypnotic medications entered a taper intervention with equal levels of psychological distress, health, self-efficacy, and readiness to change. Successful hypnotic discontinuation was associated with overall improvement of insomnia, anxiety and distress symptoms, perceived health and self-efficacy. More intensive and individualized therapeutic attention may be warranted for individuals experiencing worsening of insomnia symptoms, more withdrawal symptoms and psychological distress, and lower self-efficacy during medication discontinuation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of homework in cognitive-behavioral therapy for cocaine dependence.

This study examines the effect of homework compliance on treatment outcome in 123 participants receiving cognitive-behavioral therapy (CBT) for cocaine dependence. Regression analyses revealed a significant relationship between homework compliance and cocaine use that was moderated by readiness to change. Homework compliance predicted less cocaine use during treatment but only for participants higher in readiness to change. For those lower in readiness to change, homework compliance was not associated with cocaine use during treatment. Homework compliance early in therapy was associated with better retention in treatment. Homework compliance was not predicted by participants' level of education or readiness to change. These findings support the use of homework during CBT for substance use disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stages of Change Among Chinese People With Mental Illness: A Preliminary Study.

Objective: To determine the effect of self-efficacy and outcome expectancy on the readiness for rehabilitation among Chinese people with mental illness. Participants: Fifty-eight men and 62 women with chronic mental illness. Outcome Measures: Change Assessment Questionnaire for People With Severe and Persistent Mental Illness, Task-Specific Self-Efficacy Scale for People With Mental Illness, and Outcome-Expectancy Scale for People With Mental Illness. Results: Chinese people with mental illness can be meaningfully classified into 4 stages of change (SOC) groups: precontemplation, contemplation, ambivalent-conforming, and action-maintenance. SOCs are related to self-efficacy in interpersonal, symptoms management, and help-seeking skills as well as expectations about the benefit of social and coping skills. Conclusion: The SOC concept is useful for tailoring culturally sensitive psychiatric rehabilitation interventions for Chinese people with mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care

STUDY DESIGN: Randomized, controlled trial. OBJECTIVE: To evaluate a four-session self-management group intervention for patients with pain in primary care, led by trained lay persons with back pain. The intervention was designed to reduce patient worries, encourage self-care, and reduce activity limitations. BACKGROUND DATA: Randomized trials of educational interventions suggest that activating interventions may improve back pain outcomes. Expert opinion increasingly regards effective self-management of back pain as important in achieving good outcomes. In this study, an educational intervention designed to activate patients and support effective self-management was evaluated. METHODS: Six to 8 weeks after a primary care visit for back pain, patients were invited to participate in an educational program to improve back pain self-management. Those showing interest by returning a brief questionnaire became eligible for the study. Participants (n = 255) randomly were assigned to either a self-management group intervention or to a usual care control group. The effect of the intervention, relative to usual care, was assessed 3, 6, and 12 months after randomization, controlling for baseline values. The intervention consisted of a four-session group applying problem-solving techniques to back pain self-management, supplemented by educational materials (book and videos) supporting active management of back pain. The groups were led by lay persons trained to implement a fully structured group protocol. The control group received usual care, supplemented by a book on back pain care. RESULTS: Participants randomly assigned to the self-management groups reported significantly less worry about back pain and expressed more confidence in self-care. Roland Disability Questionnaire Scores were significantly lower among participants in the self-management groups relative to the usual care controls at 6 months (P = 0.007), and this difference was sustained at 12 months at borderline significance levels (P = 0.09). Among self-management group participants, 48% showed a 50% or greater reduction in Roland Disability Questionnaire Score at 6 months, compared with 33% among the usual care controls. CONCLUSIONS: Self-management groups led by trained lay persons following a structured protocol were more effective than usual care in reducing worries, producing positive attitudes toward self-care, and reducing activity limitations among patients with back pain in primary care.     

The URICA as a measure of motivation to change among treatment-seeking individuals with concurrent alcohol and cocaine problems.

The original 4-factor structure of the University of Rhode Island Change Assessment (URICA; C. C. DiClemente & S. 0. Hughes, 1990) was replicated, and the scale's internal consistency was found to be acceptable in a sample of 106 cocaine- and alcohol-dependent participants receiving either disulfiram or no medication in a psychotherapy trial. In addition, participants categorized as having high Committed Action (CA), a new URICA composite, had a significantly greater percentage of days abstinent from both alcohol and cocaine (85.6%) than low-CA participants (72.7%, p     

Efficacy of a computerized abuse and safety assessment intervention for women with disabilities: A randomized controlled trial.

Objective: To evaluate the effects of a computerized disability-specific abuse assessment intervention on abuse awareness, safety self-efficacy, and safety promoting behaviors of women with diverse disabilities. Research Design: A randomized control group design was used, with the intervention group completing the assessment intervention both at Time 1 (T1) and 3 months later at Time 2 (T2) and control participants completing it for the first time at T2. Analyses compared intervention and control groups at T2 and evaluated change over time in intervention group participants. The relationship between outcome variables (abuse awareness, safety self-efficacy, safety behaviors) was also explored. Results: The intervention group had greater abuse awareness than the control group at T2, and abuse awareness increased from T1 to T2 among women in the intervention group, particularly among women who had experienced little or no abuse in the past year. Both abuse awareness and safety self-efficacy were significantly related to safety behaviors. Conclusions: The computerized program offers promise as a nonthreatening method of conducting abuse assessments among women with disabilities while also serving as an intervention to enhance abuse awareness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conservation of resources theory, perceived stress, and chronic fatigue syndrome: Outcomes of a consumer-driven rehabilitation program.

Objective: To evaluate the impact of a consumer-driven rehabilitation program on perceptions of loss and gain of interpersonal relationships, energy, material objects, work benefits and opportunities, well-being, and experiences of mastery in persons with chronic fatigue syndrome. Study Design: Participants were randomly assigned to a program group (n = 23) or a control group (n = 24). Outcomes were assessed (a) at baseline, (b) after program participants completed an illness management group, and (c) after they completed one-on-one peer counseling. Setting: A community-based advocacy organization for individuals with disabilities. Interventions: Four months of illness management groups followed by 7 months of one-on-one peer counseling emphasizing goal setting and goal attainment. Main Outcome Measure: The Conservation of Resources Evaluation scale. Results: Significant gains were observed for program participants across all categories of resource gain--interpersonal, energy, material, work, well-being, and mastery resources. Effect sizes were moderate to large. Conclusions: Programs in which participatory action research methods are used may have a positive impact on resource acquisition for individuals with chronic fatigue syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)