Quality of Research
Review Date: October 2007
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Evers, K. E., Prochaska, J. O., Johnson, J. L., Mauriello, L. M., Padula, J. A., & Prochaska, J. M. (2006). A randomized clinical trial of a population- and Transtheoretical Model-based stress-management intervention. Health Psychology, 25(4), 521-529. 
Supplementary Materials Description of Pro-Change Quality Assurance Procedures and Intervention Fidelity
Pro-Change Behavior Systems, Inc. (2003). A stress management expert system for cancer prevention: Phase II final report to the National Cancer Institute (Grant #CA81948). West Kingston, RI: Author.
Pro-Change Behavior Systems, Inc. (2004). Transtheoretical Model: Scientific validity [excerpt]. West Kingston, RI: Author.
Outcomes
| Outcome 1: Progression to action or maintenance stage of effective stress management |
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Description of Measures
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Participants were given a brief description of stress management (e.g., regular relaxation, physical activity, social activities) and were asked, "Do you effectively practice stress management in your daily life?" The five response categories placed participants in one of five stages of change for effective stress management: precontemplation, contemplation, preparation, action, and maintenance.
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Key Findings
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More than 60% of individuals in the treatment group who completed the study began practicing effective stress management within 6 months and maintained the behavior up to the 18-month follow-up, compared with about 40% of control group participants, who received assessments only (p < .01).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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2.9
(0.0-4.0 scale)
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| Outcome 2: Stress management behaviors |
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Description of Measures
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Stress management behaviors were assessed using the Stress Management Behaviors Inventory (SMBI). This 24-item measure uses a 5-point scale from 1 (never) to 5 (repeatedly) to determine the behaviors individuals use most often to manage their stress. The tool has six subscales: Setting Limits, Planning, Help From Others, Professional Help, Reframing, and Unhealthy Activities.
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Key Findings
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Participants from the treatment group showed significant improvement in both the Planning and Professional Help subscales at 6-, 12-, and 18-month follow-ups compared with control group participants, who received assessments only (p = .001 to p < .01). In addition, the treatment group showed an improvement in the Help From Others subscale at 18 months (p < .001) and the Unhealthy Behaviors subscale at 6 months (p < .001) compared with the control group. There were no significant differences between the two groups on the Setting Limits and Reframing subscales.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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2.9
(0.0-4.0 scale)
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| Outcome 3: Perceived stress and coping |
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Description of Measures
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Perceived stress and coping were assessed using the 10-item Rhode Island Stress and Coping Inventory (RISCI). Using a scale from 1 (never) to 5 (repeatedly), participants reported how frequently they felt stressed or were able to cope in specific situations.
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Key Findings
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Participants from the treatment group showed a significant reduction in their perceived stress at 6-, 12-, and 18-month follow-ups compared with control group participants, who received assessments only (p < .001 to p < .01). There were no significant differences between the two groups on their perceived coping.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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| Outcome 4: Level of depression |
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Description of Measures
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Level of depression was assessed using the 11-item Center for Epidemiological Studies Depression Scale (CES-D), which asks how often in the past week an individual felt each of nine negative and two positive feelings. Responses are based on a 3-point Likert scale from 0 (hardly ever or never) to 2 (much or most of the time).
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Key Findings
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Participants in the treatment group reported significantly less frequent depression at the 6- and 18-month follow-ups compared with control group participants, who received assessments only (p < .001 and p < .01, respectively).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.5
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
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69% Female
31% Male
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85% White
8% Black or African American
6% Hispanic or Latino
1% Race/ethnicity unspecified
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Progression to action or maintenance stage of effective stress management
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2.0
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3.0
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2.5
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4.0
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2.5
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3.5
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2.9
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2: Stress management behaviors
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2.0
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3.0
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2.5
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4.0
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2.5
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3.5
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2.9
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3: Perceived stress and coping
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4.0
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3.5
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2.5
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4.0
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2.5
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3.5
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3.3
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4: Level of depression
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4.0
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4.0
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2.5
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4.0
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3.0
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3.5
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3.5
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Study Strengths The study used a rigorous design, a relatively long-term follow-up (18 months), two well-recognized measures (RISCI and CES-D), assessors blind to the experimental condition, and appropriate statistical analyses.
Study Weaknesses There was a high attrition rate within the intervention group. Adequate information was not provided about the reliability of the stage of change algorithm or the treatment of intervention fidelity. Although computerization likely ensured fidelity, no fidelity checks or quality assurance procedures were presented that would ensure the program was implemented correctly.
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Readiness for Dissemination
Review Date: October 2007
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Demonstration of online program, http://www.prochange.com/stressdemo
Evers, K. E., Prochaska, J. O., Johnson, J. L., Mauriello, L. M., Padula, J. A., & Prochaska, J. M. (2006). A randomized clinical trial of a population- and Transtheoretical Model-based stress-management intervention. Health Psychology, 25(4), 521-529.
Handouts:
- Information for Implementers
- Quality Assurance Procedures and Implementation Fidelity
Pro-Change Behavior Systems, Inc. (2003). Roadways to healthy living: A guide for effective stress management. West Kingston, RI: Author.
Pro-Change Behavior Systems, Inc. (2007). TTMX user manual. West Kingston, RI: Author.
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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3.5
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3.8
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4.0
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3.8
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Dissemination Strengths Both online and offline versions of materials are available for implementation. The program is completely self-directed, so no training is required. Technical assistance is available to support users before and during implementation. The computerized nature of the program ensures implementation fidelity, and the interactive computer application allows administrators to monitor program use and progress.
Dissemination Weaknesses No information is provided for integrating this program into the existing mental health system. The user manual provides minimal discussion of how clinicians can help clients interpret their stress management needs.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
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Item Description
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Cost
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Required by Developer
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Unlimited use of online expert system and materials
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$40,000 per year per site
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Yes
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Individual use of online expert system
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$35 per person
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Yes
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Stress management guide
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$20 each
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Yes
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Basic online training (approximately 4 hours)
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$100 per person
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No
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On-site training for coaches/counselors
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$3,000 per day per site
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No
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Technical assistance and consultation, including on customization
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$160 per hour
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No
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Quality assurance materials
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Included with implementation materials
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No
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Replications
Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.
Prochaska, J. O., Butterworth, S., Redding, C. A., Burden, V., Perrin, N., Leo, M., et al. (2008). Initial efficacy of MI, TTM tailoring and HRI's with multiple behaviors for employee health promotion. Preventive Medicine, 46(3), 226-231.
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