A controlled trial of health education in the physician's office

Screening of 6,144 patients in a general practice clinic to assist physician case-finding uncovered 983 (16%) who were uncontrolled hypertensives. Following physician recommendation, 115 patients volunteered for a controlled trial to test the effectiveness of supplementary strategies to the pharmaceutical management of high blood pressure. A study of nonparticipants indicated that about 7% of the practice population was eligible for cardiovascular health education. One group received a health education program, a second was allocated to self-monitor their blood pressure for 6 months, a third group was allocated to both strategies, and the final group, acting as a control, continued to receive their usual care. Physician monitoring of patients continued for the duration of the study and blood pressures decreased in all patients. The study's most important outcome was the joint reduction of blood pressure and medication strength. These were assessed by a "blind" clinician before and after the interventions according to criteria set out in the "stepped-care" approach to management of high blood pressure. People allocated to a health education program conducted in the doctor's common room did twice as well on this measure as those who were not so educated. Daily self-monitoring of blood pressure for 6 months proved to be too much for the majority of those so instructed. It is concluded that the general practice setting remains an important place for health education to prevent cardiac disease and suggestions are made for incorporating this into everyday practice.     

Back to the future — the history and philosophy of medicine experiment at Sydney University

History and Philosophy of Medicine has been a compulsory unit in the first year of the medical curriculum at Sydney University for the past decade. Volunteer tutors are drawn from most clinical and basic science departments, and each year the programme is organized on a theme of current importance in medical practice. This course began as an experiment because no resources were available for specialist staff, but has proved outstandingly successful in generating both student and teaching staff interest and support for the programme. Students present short tutorial papers to their peer group followed by submission of an essay which takes into account the tutorial discussion. The open book examination includes analysis of an unseen piece of primary source material as well as questions derived from the classwork. The Faculties of Arts and Science encouraged this educational experiment and several medical students have now opted to undertake a year of historical research during the intercalated B Sci(Med) programme, and a number of the tutors have enrolled in postgraduate historial or ethical programmes. We suggest that this model may permit introduction of novel courses in times of financial cutback within the Universities, and even allow a foundation to be laid for future development.     

A Group Randomized Intervention Trial Increases Participation in the School Breakfast Program in 16 Rural High Schools in Minnesota

BackgroundBreakfast consumption is associated with better diet quality and healthier weights, yet many adolescents miss breakfast. Nationally, 17.1% of students participate in the School Breakfast Program (SBP). Only 10% of high school students participate.ObjectiveOur aim was to evaluate an environmental intervention to increase SBP participation in high schools.DesignA group randomized trial was carried out from 2012 to 2015.Participants/settingNinth- and 10th-grade students enrolled in 16 rural schools in Minnesota (median 387 students) were randomized to intervention or control condition.InterventionA school-based intervention that included two key components was implemented over a 12-month period. One component focused on increasing SBP participation by increasing student access to school breakfast through changes in school breakfast service practices (eg, serving breakfast from a grab-n-go cart in the atrium; expanding breakfast service times). The other component focused on promoting school breakfast through student-directed marketing campaigns.Main outcome measureChange in school-level participation in the SBP was assessed between baseline (among ninth and tenth graders) and follow-up (among tenth and eleventh graders). School meal and attendance records were used to assess change in school-level participation rates in the SBP.Statistical analysesThe Wilcoxon test was used for analysis of difference in change in mean SBP participation rate by experimental group.ResultsThe median change in SBP participation rate between baseline and follow-up was 3% (interquartile range=13.5%) among the eight schools in the intervention group and 0.5% (interquartile range=0.7%) among the eight schools in the control group. This difference in change between groups was statistically significant (Wilcoxon test, P=0.03). The intervention effect increased throughout the intervention period, with change in mean SBP participation rate by the end of the school year reaching 10.3% (95% CI 3.0 to 17.6). However, among the intervention schools, the change in mean SBP participation rates was highly variable (range=–0.8% to 24.8%).ConclusionsInterventions designed to improve access to the SBP by reducing environmental and social barriers have potential to increase participation among high school students.     

Health service accreditation stimulating change in clinical care and human resource management processes: A study of 311 Australian hospitals

ObjectiveThis study aimed to establish whether longitudinal participation in an accreditation program is translated into improvement in continuity of quality patient care and human resource management (HRM) processes outcomes.Materials and methodsThis was a secondary data analysis of accreditation panel data from acute hospitals participating in the Australian Council on Healthcare Standards’ Evaluation and Quality Improvement Program (EQuIP). EQuIP criteria data from 311 hospitals were collected by external surveyors across 2003–2006 (Time 1) and 2007–2010 (Time 2). Mandatory accreditation criteria ratings at Time 1 were used to determine hospital performance group membership (1 = below moderate, 2 = moderate, 3 = above moderate). Analysis was undertaken of ratings across continuity of quality patient care and HRM process criteria, at Time 1 and 2.ResultsContinuity of quality patient care and HRM processes improved across time in the three performance groups. Lower performing hospitals improved at a greater rate than moderate and higher performing hospitals. The groupings and performance order did not change over time.ConclusionsAn accreditation program is an external driver that facilitates continual and systemic quality improvement changes to sub-systems with an organisation.     

Carbohydrate metabolism prospectively studied in women using a low-estrogen oral contraceptive for six months.

Twenty-four women were prospectively evaluated for their carbohydrate metabolic status before and after six months of using an oral contraceptive containing 0.035 mg ethinyl estradiol and 0.4 mg of norethindrone. At each testing, a 100-gm oral glucose load was administered and blood glucose and plasma insulin values were measured over a three-hour period. Nineteen women with "normal" control tests demonstrated a significant decrease in their fasting glucose values and two of these women (10.5%) had a slight deterioration of their glucose curves. There were no other significant glucose or insulin changes. They had no change in weight and there was a significant reduction in their blood pressure during the treatment time. Five women had "borderline abnormal" control glucose tests, and four of these (80%) improved during the six months of treatment, and two of them (40%) became "normal." Thus, there is no evidence of an adverse effect of this low-estrogen oral contraceptive on carbohydrate metabolism during six months of therapy.     

Comparative evaluation of human heat stress indices on selected hospital admissions in Sydney,Australia

Objective: To find appropriate regression model specifications for counts of the daily hospital admissions of a Sydney cohort and determine which human heat stress indices best improve the models' fit. Methods: We built parent models of eight daily counts of admission records using weather station observations, census population estimates and public holiday data. We added heat stress indices; models with lower Akaike Information Criterion scores were judged a better fit. Results: Five of the eight parent models demonstrated adequate fit. Daily maximum Simplified Wet Bulb Globe Temperature (sWBGT) consistently improved fit more than most other indices; temperature and heatwave indices also modelled some health outcomes well. Humidity and heat‐humidity indices better fit counts of patients who died following admission. Conclusions: Maximum sWBGT is an ideal measure of heat stress for these types of Sydney hospital admissions. Simple temperature indices are a good fallback where a narrower range of conditions is investigated. Implications for public health: This study confirms the importance of selecting appropriate heat stress indices for modelling. Epidemiologists projecting Sydney hospital admissions should use maximum sWBGT as a common measure of heat stress. Health organisations interested in short‐range forecasting may prefer simple temperature indices.     

三种宫颈癌新辅助化疗方案的疗效及化疗毒副反应比较研究

目的通过比较三种新辅助化疗方案在治疗宫颈癌方面的疗效及并发的毒副反应,并进行综合评价,总结出最佳新辅助化疗方案。方法回顾分析我院2008年3月至2011年12月98例放疗前或术前行新辅助化疗的宫颈癌患者,按所接受的化疗方案类别随机分为三组,其中采用顺铂＋异环磷酰胺＋博莱霉素顺（PIB）组为26例;顺铂＋长春新碱＋博来霉素＋丝裂霉素（PVBM）组为31例;顺铂＋5-氟尿嘧啶（PF）组为41例。所有患者均于化疗结束后15~20天,行宫颈癌根治术。结果 PIB组有效率达88.46%,PVBM组有效率达87.09%,PF组有效率达85.36%,新辅助化疗方案总有效率达86.73%,三组疗效差异对比,无统计学意义（P〉0.05）。而化疗毒副反应发生率较其它两组低,差异对比,有统计学意义（P〈0.05）。结论宫颈癌新辅助化疗能够有效控制宫颈病灶,为手术及放疗提供较好的准备,经综合分析,顺铂＋5-氟尿嘧啶方案相对副作用较少,可作为首选的辅助化疗方案。     

慢性肝炎肝硬化及原发性肝癌患者血清肿瘤坏死因子-α及白细胞介素-10水平变化

目的观察慢性肝炎、肝硬化以及原发性肝癌血清肿瘤坏死因子受体、白细胞介素-10水平的变化。方法回顾性分析2010年1月-2011年12月某院收治的63例肝炎肝硬化患者和57例原发性肝癌患者的血清检验资料,分析肿瘤坏死因子-α(TNF-α)及白细胞介素-10(IL-10)水平变化。结果①慢性肝炎肝硬化Child C级患者TNF-α水平(1.32±0.12)高于ChildB级(1.86±0.19)、A级(2.35±0.32),比较差异有统计学意义(P﹤0.05);慢性肝炎肝硬化Child A级患者IL-10水平(0.037±0.010)高于Child B级(0.024±0.009)、C级(0.013±0.004),比较差异有统计学意义(P﹤0.05)。②原发性肝癌组患者血清TNF-α水平(3.56±0.15)高于慢性肝炎肝硬化组患者(2.32±0.22)、对照组患者(0.63±0.10),比较差异有统计学意义(P﹤0.05);原发性肝癌患者组血清IL-10水平(0.014±0.009)低于慢性肝炎肝硬化组患者(0.027±0.012)、对照组患者(0.046±0.004),比较差异有统计学意义(P﹤0.05)。结论TNF-α和IL-10均参与慢性肝炎肝硬化和原发性肝癌的病理过程,TNF-α水平变化趋势与疾病严重程度一致,IL-10水平变化趋势与疾病严重程度相反。     

中医情志联合按摩护理在初产妇产后母乳喂养中的应用

目的：探讨中医情志联合按摩护理在初产妇产后母乳喂养中的应用效果。方法顺利分娩的100例初产妇随机分为观察组和对照组各50例,对照组给予常规护理,观察组在对照组的基础上实施中医情志联合按摩护理;比较两组产妇干预后的心理变化、泌乳量、乳房胀痛情况及纯母乳喂养率。结果观察组护理后的焦虑、抑郁评分显著下降,且低于对照组,差异有统计学意义（P＜0．05）,对照组无明显变化（P＞0．05）;观察组的泌乳量多于对照组,乳房胀痛评分低于对照组,纯母乳喂养率高于对照组,差异均有统计学意义（P＜0．05）。结论中医情志联合按摩护理能够减少初产妇产后的不良情绪和乳房胀痛程度,增加产后泌乳,提高母乳喂养率。     

Effect of a subdermal silastic implant containing norethindrone acetate on human lactation

A study was carried out to evaluate the suitability of a single silastic implant containing norethindrone acetate for contraception and its effects on lactation in a group of 35 lactating women. Of these 23 women received the implant on the 6th day after delivery and formed the early post-partum group (study group I) and 12 women received the implant six weeks after delivery and formed the late post-partum group (study group II). Fifteen women using conventional contraceptives served as the control group. A transient fall in milk protein at 2 weeks of implant insertion has been observed in the early post-partum group. A decrease in milk phosphorus content was observed between 2 to 4 months after implant insertion in the same group. No significant change was observed subjectively about the quantity of milk from the previous pregnancy in all the subjects. No qualitative changes in the chemical constituents of milk were observed in the late post-partum group as compared with the control group.     

Comparing self-rated health and self-assessed change in health in a longitudinal survey: Which is more valid?

Self-rated health (SRH) is commonly used in longitudinal analyses as a repeated outcome measure. This assumes that computed changes in SRH over time truly represent within-individual changes in underlying health. The longitudinal validity of SRH, however, is threatened by ceiling effects (where people reporting the highest level of SRH cannot report subsequent improved health), insensitivity to small changes within SRH categories, reference group effects (where individuals assess their health changes relative to their peers) and stability in SRH even when change in underlying health is occurring. We assessed the longitudinal validity of SRH by comparing computed changes in SRH with a measure of self-assessed change in health (SACH). We used two waves of data (2003-2005) from the New Zealand longitudinal Survey of Family, Income and Employment (SoFIE). Computed change in SRH and SACH were compared directly and also in regression models using an objective measure of health outcome change (hospitalisations within the past year). Computed change in SRH and SACH were not well correlated, consistent with ceiling and/or categorisation effects in SRH. In regression models, SACH was more strongly predictive of hospitalisation than computed change in SRH (worse SACH was associated with an increased odds of hospitalisation of 3.7 compared to 1.8 for decreased computed change in SRH). SACH may be affected by recall bias, but if SRH is used as a repeated outcome measure in longitudinal analyses, results may also be biased, if change in SRH does not occur in response to significant health events.     

以目标为导向的护理干预对慢性心力衰竭患者疾病认知水平及生活质量的影响

目的 探讨以目标为导向的护理干预对心力衰竭患者疾病认知水平及生活质量的影响。方法 将本院2020年2月—2022年2月接收的110例慢性心力衰竭患者根据随机数字表法分为对照组（给予常规护理）与干预组（给予目标为导向的护理）,各55例,比较2组患者3个月后的疾病认知及行为水平、心功能及生活质量（MLHFQ）评分变化。结果 干预后,6MWT干预组为（442.64±131.53）,高于对照组的（332.58±119.82）,t=4.588,P<0.001;干预组的BNP为（539.54±193.57）,低于对照组的（812.37±127.65）,t=-8.726,P<0.001;干预组的LVEF为（54.46±5.86）,高于对照组的（48.58±3.47）,t=6.403,P<0.001;差异均具有统计学意义。干预组的疾病认知评分为（51.46±3.73）,高于对照组的（45.62±3.25）,t=8.754,P<0.001;干预组的行为评分为（50.11±3.32）,高于对照组的（36.38±3.14）,t=-22.283,P<0.001;差异均具有统计学意...     

Increased mortality among Indigenous persons during and after release from prison in New South Wales

Objective: To estimate the overall and cause specific mortality of Aboriginal offenders in New South Wales (NSW), Australia. Methods: The study cohort consisted of all Aboriginal men and women aged 18 years and older who had experienced full‐time imprisonment in NSW between 1 January 1988 and 31 December 2002. Their data were linked probabilistically to the Australian National Death Index to obtain information on death. Standardised mortality ratios were calculated for all causes of death and adjusted for age, sex, and calendar year. Results: The cohort comprised 7,980 men and 1,373 women with 75,801 person years of observation. During a median follow‐up period of 8.3 years, 485 men and 73 women died, giving an overall mortality rate of 733 and 755 deaths per 100,000 person‐years. The risk of death in men was 4.8 (95% CI: 4.4–5.3) times and among women 12.6 (95% CI: 10.0–15.8) times that of the NSW residents, with a markedly elevated risk for almost all conditions. The leading cause of death was cardiovascular disease in men (112 deaths, 23%) and mental and behavioural disorders (17 deaths, 23%) in women. The risk of death was greatest following release from prison. Conclusions and Implications: High mortality rates for cardiovascular disease, a preventable and treatable condition, were seen among Aboriginal offenders. Prison has an important role to play in screening marginalised populations for a range of health conditions. This is particularly true for Indigenous offenders.     

Nutrition intervention group program based on preaction-stage-oriented change processes of the Transtheoretical Model promotes long-term reduction in dietary fat intake

OBJECTIVE: To develop and evaluate the long-term effectiveness of an intervention program, based on preaction-stage-oriented change processes of the Transtheoretical Model of Behavior Change, that could be delivered in a group setting to help participants lower dietary fat intake. DESIGN: An enhanced version of the nonequivalent control group experimental design was used. Entire sections of an undergraduate introductory nutrition science course were assigned to an experimental, pretest/posttest control, or posttest-only control group. Daily fat intake and stage of change of the experimental and pretest/posttest control groups were determined at the pretest and posttest and 1-year later at a follow-up test. Every 1 to 2 weeks during the study, stage of change of the experimental group was assessed. Daily fat intake of the experimental group was assessed at study midpoint. Daily fat intake and stage of change of the posttest-only control group was determined at the posttest. Pretest results were used to place participants of the experimental and pretest/posttest control groups in either the preaction stage (i.e., precontemplation, contemplation, or preparation) or the action/maintenance stage. SUBJECTS/SETTING: The sample consisted of 38, 30, and 42 undergraduate students who were assigned to the experimental, pretest/posttest control, and posttest-only control groups, respectively. INTERVENTION: The experimental group participated in a group-based, dietary fat intake intervention that included a series of 11 lessons taught over a 14-week period. Each lesson was based on 1 or 2 of the preaction-stage-oriented change processes of the Transtheoretical Model. MAIN OUTCOME MEASURES: Data were evaluated to determine the effects of the intervention program on long-term dietary fat reduction and stage of change progression. STATISTICAL ANALYSIS PERFORMED: Analysis of variance, repeated-measures analysis of variance, and paired t tests. RESULTS: For pretest and posttest dietary fat intake scores, stage and time were significant, and there was a significant time-by-stage interaction. Time was significant for pretest and posttest stage scores. Subjects in the preaction-stage experimental group significantly increased their mean stage of change and reduced their fat intake between the pretest and posttest; these changes persisted for 1 year. Pretest/posttest control group participants who began in a preaction stage also significantly increased their mean stage and reduced fat intake by the posttest, but these changes did not endure until the follow-up test. APPLICATIONS/CONCLUSIONS: This intervention program produced an enduring, significant reduction in mean dietary fat consumption and a significant progression in mean stage of change of subjects in the experimental group who were in the preaction stage. It may be appropriate to design group interventions to use preaction stage processes rather than the more traditionally used action and maintenance stages change processes.     

基于行为改变轮理论的健康教育与康复锻炼对全髋关节置换术后患者髋关节功能恢复的影响

目的 探讨行为改变轮理论的健康教育与康复锻炼对THA术后患者髋关节功能恢复的影响。方法 选取2018年9月—2019年8月某省三甲医院骨科行全髋关节置换术的60例患者,随机分为对照组和试验组。对照组行常规围手术期康复锻炼,试验组在此基础上按行为改变轮理论行3个月的干预,采用康复锻炼依从性评定表、髋关节功能评分量表（HHS）、康复自我效能感量表（SER）进行效果评定。结果 除术后第1天外,试验组患者术后3 d、5 d、7 d、1月及3月的康复锻炼完全依从率均优于对照组（χ2值分别为8.531、13.611、24.310、15.429、13.017, P＜0.001）。试验组患者出院前SER总分及两维度得分（t值分别为5.124、4.980、4.974）、术后1月SER总分及两维度得分（t值分别为5.216、5.224、4.805）、术后3月SER总分及两维度得分（t值分别为4.343、4.054、3.838）均高于对照组,差异有统计学意义（P＜0.001）。试验组患者术后1月、3月的HHS得分均高于对照组,差异有统计学意义（t值分别为4.482、4.274,P＜0.001）。结论 行为改变轮理论在THA术后患者中的应用,可提升患者锻炼依从性及自我效能感,促进髋关节功能的恢复。     

正常妊娠与重度子痫前期孕妇血常规参数的孕期变化对比

目的:比较重度子痫前期孕妇与正常妊娠孕妇在不同孕期下血常规参数的变化并分析其临床意义。方法:选择重度子痫前期孕妇100例为观察组,正常妊娠孕妇100例为对照组,对两组孕妇从妊娠12周起每隔4周进行血常规检查,比较两组的参数变化。结果:观察组与对照组的白细胞计数(WBC)、中性粒细胞比例(N)、淋巴细胞比例(L)在不同孕周间变化不明显,差异没有统计学意义(P>0.05)。相同孕周下两组WBC、N、L的差异没有统计学意义(P>0.05)。对照组的红细胞计数(RBC)、血红蛋白浓度(Hb)、血细胞比容(HCT)在整个妊娠过程中表现出先降低后升高的趋势。观察组RBC、Hb和HCT在不同孕周下没有表现出先降低后升高的趋势。RBC和Hb水平在孕16～35周高于对照组的同期水平,HCT水平在孕20-31周高于对照组的同期水平,差异有统计学意义(P<0.05)。观察组与对照组血小板(PLT)水平在整个妊娠过程中均表现出缓慢下降的趋势,平均血小板体积(MPV)则呈现出逐步上升的趋势。观察组PLT在孕32～39周的水平低于同期对照组的水平,MPV在孕28～35周的水平高于同期对照组的水平,差异有统计学意义(P<0.05)。结论:血常规参数在不同孕周中的变化可以大致反映孕妇的血容量、血黏度以及凝血状态的变化。有望帮助临床早期筛选出重度子痫前期孕妇,及时给予针对性的干预以减轻症状、延缓病情发展。     

经阴道彩色多普勒超声对孕早期习惯性流产的子宫血流动力学变化研究

目的:经阴道彩色多普勒超声观察早孕期各种习惯性流产的子宫动脉血流动力学变化,研究子宫动脉血流阻力指数(RI)值、搏动指数(PI)值与习惯性流产的关系。方法:经阴道彩色多普勒超声观察黄体功能不全引起的习惯性流产20例,黄体功能正常习惯性流产20例和正常群组20例各妊娠早期子宫动脉血流,对照统计各组子宫动脉RI值、PI值的相关关系及各组之间子宫动脉RI值、PI值的差异。结果:正常群组子宫动脉RI值、PI值下降,RI均值为0.792 0±0.024 4、PI均值为1.985 5±0.275 6。黄体功能正常组子宫动脉RI值、PI值增高16例,无变化或下降4例,RI均值为0.838 0±0.031 8、PI均值为2.503 5±0.268 6。黄体功能不全组子宫动脉RI值、PI值增高17例,无变化或下降3例,RI均值为0.839 0±0.032 5、PI均值为2.485 5±0.235 0。统计分析结果,正常组与黄体功能正常组、正常组与黄体功能不全组子宫动脉RI值、PI值差异有统计学意义(P<0.01),黄体功能正常组和黄体功能不全组子宫动脉RI值、PI值差异无统计学意义(P>0.05)。结论:各种原因引起的习惯性流产患者妊娠早期,无论是黄体功能不全或黄体功能正常,都可见子宫动脉RI值、PI值增高,子宫动脉RI值、PI值增高是习惯性流产发生过程中的一种病理表现,子宫动脉RI值、PI值增高是导致孕早期习惯性流产的主要发病因素。     

微卡辅助治疗新涂阳肺结核疗效分析

目的观察和评价微卡联合常规化疗药物治疗新涂阳肺结核的疗效。方法 302例新涂阳肺结核患者被随机分为治疗组和对照组,每组各151例,治疗组给予2HRZE/4H3R3加用微卡菌苗治疗6个月,对照组只用2HRZE/4H3R3治疗6个月,观察治疗后肺部病灶吸收率、痰菌阴转率、微卡治疗不良反应情况。结果治疗2、4、6月末时,治疗组病灶吸收率明显高于对照组,差异均有统计学意义（P〈0.05）。治疗组和对照组2、3、5、6月末时,治疗组痰菌转阴率明显高于对照组,差异均有统计学意义（P〈0.05）。接受微卡治疗无严重不良反应。结论微卡联合常规化疗药物治疗新涂阳肺结核病人可显著增强常规化疗效果,有助于病灶吸收好转、痰菌转阴,且有较好的安全性,可作为新涂阳肺结核的辅助治疗。     

Reduction of ischemic heart disease risk markers in the teenage children of heart attack patients.

BACKGROUND. Families of people with ischemic heart disease (IHD) are likely to share high levels of risk markers and to have similar lifestyle patterns. Teenage children in such families were the focus of a behavioral intervention program. METHODS. Families were randomly allocated to either an "early" or a "late" advice group. The late group and a third "control" group (consisting of families with no cardiovascular disease) received the intervention only after baseline measurements were repeated in all three groups at the end of 12 months. Pedigree analysis was used to compare changes across groups. RESULTS. The decrease in self-reported total fat intake was greater among teenagers in the early group (mean = -3.38, SE = 1.00) than among those in the late group (mean = -0.58, SE = 1.06), as was the decrease in saturated fat intake (mean = -2.46, SE = 0.56; mean = -0.54, SE = 0.60, respectively). These differences were statistically significant (P < 0.05). There were no differences between these groups for changes in total or high-density lipoprotein cholesterol levels. There was a statistically significant difference between the change in total cholesterol levels in the control group (mean = +0.08, SE = 0.07) and that in the late group (mean = -0.14, SE = 0.11). CONCLUSIONS. The intervention program appears to have made the teenagers aware of high-fat foods, as stated fat intake was significantly lowered, but it was not successful in decreasing blood cholesterol levels. Having a parent with IHD did, however, influence the teenagers' risk-related behavior, leading to a significant reduction in blood cholesterol levels.     

Nutrition Intervention Group Program based on Preaction-stage–oriented Change Processes of the Transtheoretical Model Promotes Long-term Reduction in Dietary Fat Intake

Objective To develop and evaluate the long-term effectiveness of an intervention program, based on preaction-stage–oriented change processes of the Transtheoretical Model of Behavior Change, that could be delivered in a group setting to help participants lower dietary fat intake.Design An enhanced version of the nonequivalent control group experimental design was used. Entire sections of an undergraduate introductory nutrition science course were assigned to an experimental, pretest/posttest control, or posttest-only control group. Daily fat intake and stage of change of the experimental and pretest/posttest control groups were determined at the pretest and posttest and 1-year later at a follow-up test. Every 1 to 2 weeks during the study, stage of change of the experimental group was assessed. Daily fat intake of the experimental group was assessed at study midpoint. Daily fat intake and stage of change of the posttest-only control group was determined at the posttest. Pretest results were used to place participants of the experimental and pretest/posttest control groups in either the preaction stage (ie, precontemplation, contemplation, or preparation) or the action/maintenance stage.Subjects/setting The sample consisted of 38, 30, and 42 undergraduate students who were assigned to the experimental, pretest/posttest control, and posttest-only control groups, respectively.Intervention The experimental group participated in a group-based, dietary fat intake intervention that included a series of 11 lessons taught over a 14-week period. Each lesson was based on 1 or 2 of the preaction-stage–oriented change processes of the Transtheoretical Model.Main outcome measures Data were evaluated to determine the effects of the intervention program on long-term dietary fat reduction and stage of change progression.Statistical analysis performed Analysis of variance, repeated-measures analysis of variance, and paired t tests.Results For pretest and posttest dietary fat intake scores, stage and time were significant, and there was a significant time-by-stage interaction. Time was significant for pretest and posttest stage scores. Subjects in the preaction-stage experimental group significantly increased their mean stage of change and reduced their fat intake between the pretest and posttest; these changes persisted for 1 year. Pretest/posttest control group participants who began in a preaction stage also significantly increased their mean stage and reduced fat intake by the posttest, but these changes did not endure until the follow-up test.Applications/conclusions This intervention program produced an enduring, significant reduction in mean dietary fat consumption and a significant progression in mean stage of change of subjects in the experimental group who were in the preaction stage. It may be appropriate to design group interventions to use preaction stage processes rather than the more traditionally used action and maintenance stages change processes. J Am Diet Assoc. 2000;100:335-342.