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A 'stages of change' approach to helping patients change behavior.

Helping patients change behavior is an important role for family physicians. Change interventions are especially useful in addressing lifestyle modification for disease prevention, long-term disease management and addictions. The concepts of "patient noncompliance" and motivation often focus on patient failure. Understanding patient readiness to make change, appreciating barriers to change and helping patients anticipate relapse can improve patient satisfaction and lower physician frustration during the change process. In this article, we review the Transtheoretical Model of Change, also known as the Stages of Change model, and discuss its application to the family practice setting. The Readiness to Change Ruler and the Agenda-Setting Chart are two simple tools that can be used in the office to promote discussion.

Behavior Therapy↗

A staged-based approach to helping people change health behaviors.

Helping people change health-related behavior is a challenging part of CNS responsibilities. Behavior change is a cyclic phenomena where people progress through the typical stages of precontemplation, contemplation, preparation, action, maintenance, and, if not successful in changing behavior, relapse. Several interventions are available to assist people with health behavior change, in addition to the typical education that CNSs provide. Appropriate nursing interventions for each change stage that assist people to change health behaviors successfully are described in this article.

Health Behavior↗

Attributions of the "causes" of group performance as an alternative explanation of the relationship between organizational citizenship behavior and organizational performance.

The purpose of this study was to examine the possibility that feedback regarding team performance may influence team members' reports of organizational citizenship behaviors. Ninety-five teams of business students (N = 412) participated in a labor-scheduling simulation over a local area network. Teams were provided with false negative, false positive, or neutral feedback regarding their performance. Results support the hypothesis that the perception of 2 forms of organizational citizenship behavior (helping behavior and civic virtue) in work groups may, in part. be a function of the nature of the performance feedback that group members receive. However, negative feedback appears to play a more critical role than positive feedback in this attributional process. Possible reasons for these findings, as well as their implications, are discussed.

Adult↗

Assessing adolescents' prosocial behavior: the Family Helping Inventory.

This study examined the structure and psychometric properties of a self-report measure of adolescents' helping behavior within the family--the Family Helping Inventory (FHI)--and of its two scales, the Sibling Helping Scale (SHS) and the Parent Helping Scale (PHS). The FHI was administered to 202 adolescents along with several existing measures of prosocial tendencies and with a measure of Machiavellianism. Factor analyses yielded four internally consistent subscales for the SHS and five for the PHS, all of which were conceptually related to inventories reflecting family support among adults. Both convergent and discriminant validity were demonstrated as well.

Adolescent↗

A behavioral comparison of the helping styles of nursing students, psychotherapists, crisis interveners, and untrained individuals.

Helping styles of nursing students were compared with those of subjects in a prior study (17 psychotherapists, 12 crisis interveners, and 15 untrained people). Subjects were 30 junior-year college students in the second part of a two-course sequence in interpersonal relations. The subjects were videotaped in a 3-minute interaction with a simulated client. An experienced psychotherapist who was trained in the use of the Helping Skills Verbal Response System instrument rated each student. The helping behaviors of nursing students were found to resemble those of trained mental health practitioners; their behavior was significantly different from those of untrained individuals, who were highly verbose, directive, and used minimal reflection of affect or content.

Adult↗

An educational test of health behavior models in relation to emergency helping.

This study used a true experimental design to evaluate the quality and occurrence of emergency helping behavior among university first-aid students in response to a supplemental educational unit designed to improve bystander helping. The educational unit addressed the inhibitors of emergency helping behavior within the framework of bystander behavior models and was delivered using several behavior modification strategies. Using chi-square analysis, it was found that the 43 treatment students exposed to the supplemental unit responded appropriately to a simulated emergency more often than 41 similar control students not exposed to the unit (32.6% vs. 7.3%, p = .004) and that the effect was confined primarily to women (p = .001). Future emergency care education incorporating similar theory-based educational strategies might improve trained bystander responsiveness and thus enhance the efficiency of prehospital care. Theoretical and future research implications are discussed.

Curriculum↗

Help-seeking behaviors of people with sexual problems.

Help-seeking activities associated with the sexual problems of community respondents (N = 503) were studied. Major findings include (i) a majority of respondents reported some form of social help-seeking from predominantly informal rather than professional helpers; (ii) a significant increase over early adulthood in the likelihood of reporting a dyadic sexual problem was evidenced, however there was no parallel change in help-seeking behaviors with age; (iii) help-seeking from intimates was associated with obtaining help from other informal contacts; (iv) help-seeking from extrafamilial, but not familial, supports was found to covary with income, and (v) a "normative" sequence to help-seeking behaviors was identified. Also discussed is the present work's relevance to research on human immunodeficiency virus transmission.

Adult↗

Apportioning illness management authority: how diabetic individuals evaluate and respond to spousal help.

This study explores spousal helping behavior related to diabetes management as seen from the perspective of the person with diabetes. Individuals with diabetes described spousal behaviors considered helpful in one context that were considered intrusive or unhelpful in other situations. When the helpful and unhelpful situations were compared, two factors emerged that were fundamental influences in subjects' acceptance or rejection of help and the manner in which it was accepted or refused. These factors were perceived need for help and subjects' perception of spousal motivation for action. Combinations of these factors gave rise to four distinct response patterns: grudging acceptance of help, grateful acceptance of help, respectful rejection of help, and punitive rejection of help. The impact of these response patterns on diabetes management is discussed.

Adult↗

[Self-control, stimulus control, relapse prevention. Behavior therapy helps in weight reduction].

Behavioral therapy is an essential part of the overall strategy for treating obesity. Successes are most evident in short-term treatment, whereas the value of the long-term approach is more difficult to assess due to a lack of adequate data. The aims of behavior-modifying measures are improving eating habits and nutritional awareness, increasing physical activity, and improving strategies for coping with psychological and social consequences. At the focus of behavioral therapeutic techniques aimed at combatting obesity is self-observation supported by stimulus-control techniques, reinforcement techniques, and help with cognitive restructuring. Furthermore, patients learn how to avoid relapse. Success over the long-term can be improved by active follow-up measures and depends, among other things, on adequate quality control. The appropriate approaches to therapeutic programs must be made transparent both to the patient involved and concerned professionals.

Behavior Therapy↗

Domestic violence and help-seeking behaviors among rural women: results from a shelter-based study.

Research on domestic violence and help-seeking behaviors of women living in rural communities has been limited. This study adds to existing knowledge by examining this type of violence along with mental health characteristics and related help-seeking behaviors of a sample of predominantly Hispanic women seeking shelter at a rural domestic violence shelter. Study participants experienced physical, verbal, emotional, and sexual abuse, harassment, stalking, and abuse with a weapon in their current intimate relationship. Twenty-four percent of study participants of Hispanic backgrounds and 10% of participants from all other racial/ethnic groups reported experiencing all types of abuse listed above. When compared with other study participants, a greater percentage of Hispanic participants indicated that they had thought of and/or attempted suicide. Participants' help-seeking behaviors from formal support systems suggest a mismatch between the types of abuse experienced and the resultant help-seeking behaviors they used. These help-seeking behaviors also indicate the relevance of mental health characteristics (e.g., suicide ideation) in these behaviors. These and findings from other studies may provide the impetus for a systematic documentation of domestic violence and help-seeking behaviors of women living in rural communities.

Adolescent↗

Health-related, help-seeking behaviors in female Mexican-American adolescents.

PURPOSE: To explore and describe the health-related, help-seeking behaviors of young female Mexican-American adolescents. DESIGN: Qualitative exploratory-descriptive design using focus groups. SETTING: Community recreation centers. PARTICIPANTS: 18 female Mexican-Americans ages 10-16 years residing in a South Central state. MAIN OUTCOME MEASURES: A demographic information form and semi-structured interview designed for the study. RESULTS: Subjects described two themes of help-seeking behaviors: seeking help for physical health problems and preventive healthcare from formal sources (i.e., community health clinics, family physicians, and public schools), and seeking help for concerns about pubertal development and pregnancy from informal sources (i.e., their mothers, aunts, sisters, and friends). CONCLUSION: While young, female Hispanic adolescents may seek help from formal sources for preventive healthcare services and physical health problems not related to sexuality, they tend to seek help from informal sources for psychosocial and sexuality issues. Community-based interventions should be developed that focus on the importance of this pattern of help-seeking behaviors for young female Hispanics.

Adolescent↗

Perceptions of the most helpful nursing behaviors in a home-care hospice setting: caregivers and nurses.

The purpose of this study was to determine those nursing behaviors perceived as most helpful and least helpful by primary caregivers and by hospice nurses in a home-care hospice setting. A Q-sort of 60 nursing behaviors ranked from most to least helpful was completed by 20 caregivers, during the bereavement period and by five hospice nurses, who were currently employed by the hospice. These nursing behaviors were categorized as: Nursing behaviors related to the patient's physical needs; nursing behaviors related to the patient's psychosocial needs; and nursing behaviors related to the psychosocial needs of the caregivers.

Adult↗

Help-seeking behavior and attitude of Chinese Americans regarding psychological problems.

Investigated the help-seeking behavior and attitude regarding psychological problems as mediated by mental health status, acculturation level, and sociodemographic characteristics in a community sample of Chinese Americans. Of the 128 respondents, 17 (13.3%) had consulted professional help for a nervous or emotional problem. Compared to the others, they reported significantly poorer mental health status (i.e., had more physical symptoms, had once come close to experiencing a "nervous breakdown," and had a relative who had been in treatment), and were more likely to be American-born. For those who had not previously sought help, attitude toward help seeking was examined. A positive attitude was mediated by superior English ability, being younger, married, and from a lower SES background. The findings suggested help-seeking behavior is primarily mediated by presence of need, whereas attitude reflected a general propensity. Acculturation was an important predictor of both behavior and attitude, with the less acculturated most in need of education about the utility of mental health service.

Acculturation↗

[An analysis of decision-making process in help-seeking behavior].

The purpose of this study was to analyze decision-making process in help-seeking behavior with the information monitoring method. Four simulated situations were prepared in which help became necessary. Eight categories of further situational information were explained, and 67 subjects were asked to indicate which categories of information they would like to see before actually seeking others' help in each of the four situations. The number and categories of information requested, together with their order, were recorded. Also, questions were asked concerning the difficulty, hesitation, and confidence they had felt during the task, and ratings were made regarding how adequate the eight information categories and how real the four situations were. Results suggested that (1) only two steps were taken before a help-seeking decision was made in every situation, and (2) it was made in a fairly fixed pattern in term of the help's possible cost and probable attributions of why it became necessary.

Adult↗

Community based study to estimate prevalence, burden of illness and help seeking behavior in rheumatic diseases in Mexico City. A COPCORD study.

OBJECTIVE: To estimate the prevalence, burden of illness and help seeking behavior of musculoskeletal complaints and provide point prevalence estimates of osteoarthritis, low back pain, fibromyalgia, rheumatoid arthritis and gout among adult population in a suburban community in Mexico city. METHODS: Home survey of adults in a balanced and stratified sample validated against physical exam. Three trained interviewers applied a validated COPCORD core questionnaire. Subjects with pain (in the last seven days or ever) > or = 4 (0-10) and no trauma; or with current or past disability were evaluated preferably the same day by a trained clinician in a structured interview. A diagnosis using ACR criteria when available, recommendation or referral was provided as required. Analysis was based on descriptive statistics of participant characteristics, pain site and distribution, patterns of help seeking behavior. Point prevalence with 95% confidence intervals of most common diseases and associated disability rate. RESULTS: 1169 men and 1331 women were included. Pain in the last 7 days not associated with trauma was reported in 419 (17%) participants. The most common sites of involvement were knee (12.3%); low back (6.3%); ankles (6%) and shoulders (5.3%). The mean/SD pain score was 4.8/2.5. Thirteen percent of the total sample had some treatment. The general practitioner treated 72% of those; 75% perceived good efficacy with medications. Point prevalence estimates and 95% CI were: disability: 1.4% (0.0-1.9); osteoarthritis: 2.3% (1.7-2.9); fibromyalgia: 1.4 (1.0-2.0); low back pain: 6.3% (5.4-7.3); rheumatoid arthritis: 0.3% (0.1-0.6) and gout 0.4% (0.1-0.7). CONCLUSION: Pain in the last 7 days due to musculoskeletal disorders is 17% in this community. Medications were commonly prescribed. Point prevalence estimates of most common diagnoses was similar to other community surveys using COPCORD methodology but very different help seeking behavior.

Adolescent↗