Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms.
BACKGROUND
Treating multiple health behavior risks on a population basis is one of the most promising approaches to enhancing health and reducing health care costs. Previous research demonstrated the efficacy of expert system interventions for three behaviors in a population of parents. The interventions provide individualized feedback that guides participants through the stages of change for each of their risk behaviors. This study extended that research to a more representative population of patients from primary care practice and to targeting of four rather than three behaviors.


METHODS
Stage-based expert systems were applied to reduce smoking, improve diet, decrease sun exposure, and prevent relapse from regular mammography. A randomized clinical controlled trial recruited 69.2% of primary care patients (N = 5407) at home via telephone. Three intervention contacts were delivered for each risk factor at 0, 6, and 12 months. The primary outcome measures were the percentages of at-risk patients at baseline who progressed to the action or maintenance stages at 24-month follow-up for each of the risk behaviors.


RESULTS
Significant treatment effects were found for each of the four behaviors, with 25.4% of intervention patients in action or maintenance for smoking, 28.8% for diet, and 23.4% for sun exposure. The treatment group had less relapse from regular mammography than the control group (6% vs. 10%).


CONCLUSIONS
Proactive, home-based, and stage-matched expert systems can produce relatively high population impacts on multiple behavior risks for cancer and other chronic diseases.
Prochaska
James O
JO
Cancer Prevention Research Center, University of Rhode Island, Kingston, RI 02881, USA. jop@uri.edu
Velicer
Wayne F
WF
Redding
Colleen
C
Rossi
Joseph S
JS
Goldstein
Michael
M
DePue
Judith
J
Greene
Geoffrey W
GW
Rossi
Susan R
SR
Sun
Xiaowu
X
Fava
Joseph L
JL
Laforge
Robert
R
Rakowski
William
W
Plummer
Brett A
BA
D000328:Adult; D005103:Expert Systems; D005247:Feeding Behavior; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008327:Mammography; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000517:prevention & control*; D011320:Primary Health Care; D012044:Regression Analysis; D016037:Single-Blind Method; D012878:Skin Neoplasms / Q000517:prevention & control; D016540:Smoking Cessation; D013689:Telephone; D013813:Therapy, Computer-Assisted