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Using behavior change plans to improve medical student self-care.

ABSTRACT: To describe an innovative approach to teaching medical students the principles and practice of health behavior change and self-care using a behavior change plan (BCP).Second-year medical students at Northwestern University Feinberg School of Medicine (n = 343) took a required Healthy Living unit in 2008 or 2009. They completed a BCP project in which they selected a personal behavior to change (exercise, nutrition, sleep, personal habits/hygiene, study/work habits, or mental/emotional health), set a goal, tracked progress, and self-assessed success. The authors employed a one-group posttest-only design to conduct a quantitative analysis and a qualitative evaluation of students' BCPs and their attitudes concerning the project.Among the 343 students, 299 (87.2%) set BCP goals related to exercise, nutrition, or sleep. BCP outcomes varied: 139 students (40.5%) achieved their goal, 170 (49.6%) failed to do so, and 34 (9.9%) were uncertain. Factor analysis produced two independent attitude scales: utility (? = .80) and burden (? = .67). Logistic regression showed that success approached statistical significance only in the sleep behavior category and for the utility attitude scale. Qualitative case reports provide insights about BCP targets, management, and results. After completing the assignment, 274 (79.9%) of the students considered themselves to be healthier, and 281 (81.9%) indicated they would use the process again.Completing a BCP is a valuable and effective exercise that enables medical students to practice the strategies and skills and experience the obstacles of changing health behavior.

SUBMITTER: Kushner RF

PROVIDER: S-EPMC3128665 | biostudies-literature | 2011 Jul

REPOSITORIES: biostudies-literature

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Using behavior change plans to improve medical student self-care.

Kushner Robert F RF Kessler Sheila S McGaghie William C WC

Academic medicine : journal of the Association of American Medical Colleges 20110701 7

<h4>Purpose</h4>To describe an innovative approach to teaching medical students the principles and practice of health behavior change and self-care using a behavior change plan (BCP).<h4>Method</h4>Second-year medical students at Northwestern University Feinberg School of Medicine (n = 343) took a required Healthy Living unit in 2008 or 2009. They completed a BCP project in which they selected a personal behavior to change (exercise, nutrition, sleep, personal habits/hygiene, study/work habits, ...[more]

PMID: 21617509

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Project description:mHealth interventions can help to improve the physical well-being of participants. Unfortunately, mHealth interventions often have low adherence and high attrition. One possible way to increase adherence is instructing participants to complete self-affirmation exercises. Self-affirmation exercises have been effective in increasing many types of positive behaviors. However, self-affirmation exercises often involve extensive essay writing, a task that is not easy to complete on mobile platforms.This study aimed to adapt a self-affirmation exercise to a form better suited for delivery through a mobile app targeting healthy eating behaviors, and to test the effect of differing self-affirmation doses on adherence to behavior change goals over time.We examined how varied self-affirmation doses affected behavior change in an mHealth app targeting healthy eating that participants used for 28 days. We divided participants into the 4 total conditions using a 2×2 factorial design. The first independent variable was whether the participant received an initial self-affirmation exercise. The second independent variable was whether the participant received ongoing booster self-affirmations throughout the 28-day study. To examine possible mechanisms through which self-affirmation may cause positive behavior change, we analyzed three aspects of self-affirmation effects in our research. First, we analyzed how adherence was affected by self-affirmation exercises. Second, we analyzed whether self-affirmation exercises reduced attrition rates from the app. Third, we examined a model for self-affirmation behavior change.Analysis of 3556 observations from 127 participants indicated that higher doses of self-affirmation resulted in improved adherence to mHealth intervention goals (coefficient 1.42, SE 0.71, P=.04). This increased adherence did not seem to translate to a decrease in participant attrition (P value range .61-.96), although our definition of attrition was conservative. Finally, we examined the mechanisms by which self-affirmation may have affected intentions of behavior change; we built a model of intention (R2=.39, P<.001), but self-affirmation did not directly affect final intentions (P value range .09-.93).Self-affirmations can successfully increase adherence to recommended diet and health goals in the context of an mHealth app. However, this increase in adherence does not seem to reduce overall attrition. The self-affirmation exercises we developed were simple to implement and had a low cost for both users and developers. While this study focused on an mHealth app for healthy eating, we recommend that other mHealth apps integrate similar self-affirmation exercises to examine effectiveness in other behaviors and contexts.

Project description:BackgroundThe popularization of mobile health (mHealth) apps for public health or medical care purposes has transformed human life substantially, improving lifestyle behaviors and chronic condition management.ObjectiveThis review aimed to identify behavior change techniques (BCTs) commonly used in mHealth, assess their effectiveness based on the evidence reported in interventions and reviews to highlight the most appropriate techniques to design an optimal strategy to improve adherence to data reporting, and provide recommendations for future interventions and research.MethodsWe performed a systematic review of studies published between 2010 and 2021 in relevant scientific databases to identify and analyze mHealth interventions using BCTs that evaluated their effectiveness in terms of user adherence. Search terms included a mix of general (eg, data, information, and adherence), computer science (eg, mHealth and BCTs), and medicine (eg, personalized medicine) terms.ResultsThis systematic review included 24 studies and revealed that the most frequently used BCTs in the studies were feedback and monitoring (n=20), goals and planning (n=14), associations (n=14), shaping knowledge (n=12), and personalization (n=7). However, we found mixed effectiveness of the techniques in mHealth outcomes, having more effective than ineffective outcomes in the evaluation of apps implementing techniques from the feedback and monitoring, goals and planning, associations, and personalization categories, but we could not infer causality with the results and suggest that there is still a need to improve the use of these and many common BCTs for better outcomes.ConclusionsPersonalization, associations, and goals and planning techniques were the most used BCTs in effective trials regarding adherence to mHealth apps. However, they are not necessarily the most effective since there are studies that use these techniques and do not report significant results in the proposed objectives; there is a notable overlap of BCTs within implemented app components, suggesting a need to better understand best practices for applying (a combination of) such techniques and to obtain details on the specific BCTs used in mHealth interventions. Future research should focus on studies with longer follow-up periods to determine the effectiveness of mHealth interventions on behavior change to overcome the limited evidence in the current literature, which has mostly small-sized and single-arm experiments with a short follow-up period.

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Using behavior change plans to improve medical student self-care.

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Using behavior change plans to improve medical student self-care.

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