Research Article: Implementation of a Tool to Modify Behavior in a Chronic Disease Management Program

Date Published: March 8, 2011

Publisher: SAGE-Hindawi Access to Research

Author(s): Nicole D. Gillespie, Thomas L. Lenz.


Chronic diseases like diabetes, hypertension, and dyslipidemia continue to be a significant burden on the US health care system. As a result, many healthcare providers are implementing strategies to prevent the incidence of heart disease and other chronic conditions. Among these strategies are proper drug therapy and lifestyle modifications. Behavior change is often the rate-limiting step in the prevention and maintenance of lifestyle modifications. The purpose of this paper is to describe a tool used to guide the progression and assess the effectiveness of a cardiovascular risk reduction program. The tool uses the Transtheoretical Model of Behavior Change to determine the readiness and confidence to change specific lifestyle behaviors pertinent to cardiovascular health. The tool aids the practitioner in developing a patient-centered plan to implement and maintain lifestyle changes and can be tailored to use in any situation requiring a behavior change on the part of the patient.

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Health behavior change is a key component in the prevention of disease. Studies have shown that 90% of type 2 diabetes, 80% of coronary artery disease, and 70% of all strokes are potentially preventable by a combination of nonsmoking, maintenance of a healthy bodyweight, regular physical activity, healthy eating habits, and moderate alcohol consumption [1]. Unfortunately, behavior change is often the rate-limiting step in the implementation and maintenance of these preventive lifestyle behaviors.

The baseline and six-month ratings for the “readiness-to-change” questionnaire are shown in Table 1. The ratings are listed as aggregate mean values for the subjects under evaluation. Categories with a statistically significant increased change in readiness (P < .005) were incorporating extra physical activity throughout the daily routine, implementing specific lifestyle strategies to help with lifestyle modifications, and living an overall healthy lifestyle. These three categories also showed the greatest degree of difference from baseline to six months. As a standard of practice, the data from the completed questionnaires are used by the clinical staff to determine which behaviors to address first, help set patient-driven goals, determine what the patient is not interested in changing, and determine the participant's stage of readiness to consistently participate in a behavior. The information from the questionnaires can also be used to assess the efficacy and progress of the program itself, as well as the progression of the patient. Health behavior change is often considered the rate-limiting step in lifestyle medicine programs. The “readiness-to-change” and “confidence-to-change” tools can effectively be used to implement health behavior change strategies at a patient-specific level. The tool can be tailored to fit any program aiming to change behavior and can be applied to a variety of practice types.   Source:


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