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

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. 1. Introduction 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 Transtheoretical Model of Behavior Change was developed to understand how individuals progress towards establishing and maintaining health behavior change for optimal health [2]. The model consists of six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. The key to using this theory in practice is to assess the patient’s stage and then educate and persuade the patient to move toward the action, maintenance, and termination stages [2]. The model is widely used by practitioners in the realm of substance abuse [3], as well as independently increasing physical activity [4] and proper nutrition [5]. However, there is little literature describing its practical use in a behavior change program that implements more than one behavior change. In 2008, a comprehensive cardiovascular risk reduction program (CVRRP) was developed at a private Midwestern university to curb the progression of cardiovascular disease in its employees [6]. The program offers the participants an individualized lifestyle medication program that targets