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Emerging Infectious Diseases Journal
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Volume 1: No. 4, October 2004

SPECIAL TOPICS IN PUBLIC HEALTH
The eHealth Behavior Management Model: A Stage-Based Approach to Behavior Change and Management

Figure 1: Algorithm for eHealth Behavior Management Model.

The algorithm for the eHealth Behavior Management Model represents the communication flow that occurs between participant and computer (as explained in the text). The algorithm starts with a persuasive statement and opening question and continues through a series of statements containing empowering feedback, persuasive arguments, and yes/no questions. A total of five end nodes are possible: Maintenance, Action, Preparation, Contemplation, and Precontemplation. Each end node contains information on how the participant can implement the desired behavior change.

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Figure 2: Intent to change option of the eHealth Behavior Management Model.

The intent to change option of the eHealth Behavior Management Model continues communication flow between user and computer once the user reaches an end node in the eHealth Behavior Management Model (as explained in the text). The algorithm starts with a persuasive statement and opening question and continues through a series of statements containing empowering feedback, persuasive arguments, and yes/no questions. A total of five end nodes are possible: Maintenance, Action, Preparation, Contemplation, and Precontemplation. If the participant reaches a Preparation, Contemplation or Precontemplation end node, the model will provide an opportunity to strengthen intent to change by guiding the user from one stage of change to the next (e.g., Precontemplation to Contemplation) using a feedback loop.

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Figure 3: Feeding-environment skills algorithm of the eHealth Behavior Management Model.

The feeding-environment skills algorithm represents the possible sequence of questions, responses, and feedback between computer and user in determining family mealtime behaviors (as explained in the text). The module begins with the question "Which best describes your mealtime?" Based on responses to questions, users arrive in one of five stages of readiness to change. Final steps include exiting the survey and reviewing checklists.

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Figure 4: Managing Environmental Triggers, one of four modules within the Asthma Management Demonstration Project.

This module uses empowering statements, persuasive arguments, and transactional question to stage users based on stage of readiness to change behavior (as explained in text). The module begins with the question, "Do you know what causes you to have asthma symptoms?" If the answers to initial questions do not link users to one of the three other modules within the project, users eventually arrive in one of five stages of readiness to change in the Managing Environmental Triggers module. Final steps include linking to end nodes or viewing vignettes.

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Figure 5: Accessing Asthma Services, one of four modules within the Asthma Management Demonstration Project.

This module uses empowering statements, persuasive arguments, and transactional questions to stage users based on stage of readiness to change behavior (as explained in text), and is designed to help users determine effective forms of asthma services and how to access them. The opening question is, "Have you been diagnosed with asthma by a doctor?" Users eventually arrive in one of five stages of readiness to change. Final steps include linking to end nodes or viewing vignettes.

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Figure 6: Using Prescription Drugs Properly, one of four modules within the Asthma Management Demonstration Project.

This module uses empowering statements, persuasive arguments, and transactional question to stage users based on stage of readiness to change behavior (as explained in text). The user is prompted with the first question, “Do you have a prescription for asthma medication?” Users eventually arrive in one of five stages of readiness to change. Final steps include linking to end nodes or viewing vignettes.

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Figure 7: Regular Peak Flow Monitoring, one of four modules within the Asthma Management Demonstration Project.

This module uses empowering statements, persuasive arguments, and transactional question to stage users based on stage of readiness to change behavior (as explained in text). The opening question is, "Do you use peak flow monitoring correctly on a daily basis?" Users eventually arrive in one of five stages of readiness to change. Final steps include linking to end nodes or viewing vignettes.

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Figure 8: HIV/AIDS Prevention Assertive Communication Module currently in development for South African women at University of Port Elizabeth, South Africa.

This module shows the possible communication flow that occurs between user and computer in determining behavior in sexual/romantic relationships and encouraging positive changes in behavior. The opening question is, "Which statement best describes your typical behavior in romantic relationships?" Based on how the user responds to the seven possible answers, the user takes one of two paths. One path begins with, "It's wonderful that you know how to assert yourself in your relationships." The second path begins with, "Many women find themselves sacrificing their needs for the sake of their partners." The module offers ideas for helping women to continue positive behavior, such as "Keep communicating with your partner" and "Identify a friend you can talk to." The module also asks questions of women who demonstrate a lack of assertiveness, such as "What are the reasons that you can't communicate your needs assertively with your partner?"

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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.


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