BACKGROUND:Many of our daily behaviors are habitual, occurring automatically in response to learned contextual cues, and with minimal need for cognitive and self-regulatory resources. Behavioral habit strength predicts adherence to actions, including to medications. The time of day (morning vs. evening) may influence adherence and habit strength to the degree that stability of contexts/routines varies throughout the day. PURPOSE:The current study evaluates whether patients are more adherent to morning versus evening doses of medication and if morning doses show evidence of greater habit strength than evening doses. METHODS:Objective adherence data (exact timing of pill dosing) were collected in an observational study by electronic monitoring pill bottles in a sample of patients on twice-daily pills for Type 2 diabetes (N = 51) over the course of 1 month. RESULTS:Data supported the hypothesis that patients would miss fewer morning than evening pills. However, counter to the hypothesis, variability in dose timing (an indicator of habit strength) was not significantly different for morning versus evening pills. CONCLUSIONS:Findings suggest that medication adherence may be greater in the morning than in the evening. However, more research is needed to evaluate the role of habitual action in this greater adherence. Furthermore, future research should evaluate the validity of behavioral timing consistency as an indicator of habit strength.

We describe the cognitive processes, illness-specific prototypes, and deep-level schemata (acute/episodic/chronic) that generate the mental representations (illness and treatment representations) guiding people's selection, performance, and evaluation of medically prescribed treatments or self-selected actions to prevent and control illness threats. These processes can be activated by external cues, media, illness in others, and one's own symptoms and changes in function. Illness and treatment representations include explanations of causes, expectations for symptom duration, impact on daily function, and response to treatment. Failure to meet expectations instigates help seeking, such as talking to family members or seeking healthcare. We indicate that understanding these processes is critical for developing effective interventions, though not required nor typically involved in predictive modeling. Testing a process mode such as CSM requires selecting the determinant of behavior actively impacting the outcome, for example, illness representations (symptoms) for care seeking and treatment representations (outcomes of treatment) for chronic management.

Objective This study examined the impact of a survivorship planning consultation (SPC) for patients with Hodgkin's lymphoma and diffuses large B-cell lymphoma on quality of life (QOL). We specifically assessed two potential moderators, cancer worry and perceived empathy, of the intervention effects on QOL. Methods This cluster randomized, four-site trial examined the efficacy of a SPC; physicians received communication skills training and applied these skills in a survivorship-focused office visit using a care plan vs a control arm in which physicians were trained to and subsequently provided a time-controlled, manualized wellness rehabilitation consultation focused only on discussion of healthy nutrition and exercise. We examined the effect of the intervention on patients' QOL and examined potential moderators-cancer worry and perceived physician empathy. Results Forty-two physicians and 198 patients participated. There was no main effect of the intervention on any of the QOL dimensions (ps > 0.10). However, cancer worry was a significant moderator of the effects of the intervention on three QOL domains (physicalP= .04; socialP= .04; spiritualP= .01) and perceived empathy was a significant moderator of QOL (physicalP= .004; psychologicalP= .04; socialP= .01). Specifically, the beneficial effects of the intervention were more pronounced among patients who initially reported higher levels of cancer worry and lower levels of physician empathy. Conclusions This study identified two factors, perceived empathy and cancer worry, that were found to impact the QOL of patients who participated in this communication-based survivorship intervention.

This chapter provides an overview of our research into how people interpret and cope with health threats. The chapter is divided into four sections. The first explains the theoretical model guiding our research effort. The second describes the application of the model to long-term, asymptomatic illnesses such as hypertension. The third section examines studies on coping with stressful medical treatments, especially cancer chemotherapy. The fourth section briefly discusses interventions, i.e., the process of changing knowledge and attitudes to alter health and illness behaviors. The basic theme uniting these sections is that individuals are motivated to regulate or minimize their health-related risks and to act to reduce these health threats in ways consistent with their perceptions of them.

Modelling the automatic and deliberative processes that interact and underlie common-sense perceptions and behaviours for managing health and illness requires prototypes at multiple levels; specific illnesses and treatments at the 'surface' and generic acute, episodic and chronic prototypes at deeper levels. Models need to represent how multi-level processing can generate inconsistent as well as consistent expectations regarding successful management and how the limited visibility of process affects communication and symptom labelling by practitioners.

OBJECTIVE:To test the association of chronic obstructive pulmonary disease (COPD) illness and medication beliefs with those specific to hypertension or diabetes in patients with COPD and coexisting chronic conditions. METHODS:A cross-sectional analysis of data collected from a sample of 282 adults with COPD and comorbid hypertension or diabetes recruited from primary care practices in New York, NY, and Chicago, IL. Beliefs about COPD, hypertension, and diabetes were measured using the Brief Illness Perception Questionnaire. Higher scores indicate a more adaptive view of the illness. Beliefs about medications were measured using the 10-item Beliefs about Medicines Questionnaire; higher scores on the two subscales indicate increased concerns and necessity, respectively. RESULTS:In adjusted analyses, scores for COPD and hypertension as well as COPD and diabetes illness beliefs, medication necessity, and medication concern were significantly associated. CONCLUSION:Patients with COPD and comorbid hypertension or diabetes have consistent beliefs about their diseases and the medications used to treat them. PRACTICE IMPLICATIONS:The consistency of beliefs across conditions may help in the development of a more holistic approach to disease management in patients with COPD who have comorbid illnesses and contribute to a better understanding of the Common-Sense Model of Illness Representation.

Conceptual frameworks are useful in research because they can highlight priority research domains, inform decisions about interventions, identify outcomes and factors to measure, and display how factors might relate to each other to generate and test hypotheses. Discovery, translational, and implementation research are all critical to the overall mission of genomic medicine and prevention, but they have yet to be organized into a unified conceptual framework. To fill this gap, our diverse team collaborated to develop the Genomic Medicine Integrative Research (GMIR) Framework, a simple but comprehensive tool to aid the genomics community in developing research questions, strategies, and measures and in integrating genomic medicine and prevention into clinical practice. Here we present the GMIR Framework and its development, along with examples of its use for research development, demonstrating how we applied it to select and harmonize measures for use across diverse genomic medicine implementation projects. Researchers can utilize the GMIR Framework for their own research, collaborative investigations, and clinical implementation efforts; clinicians can use it to establish and evaluate programs; and all stakeholders can use it to help allocate resources and make sure that the full complexity of etiology is included in research and program design, development, and evaluation.

Objectives: Fear of cancer recurrence (FCR) is a common experience among cancer survivors and often persists after the termination of cancer treatments. The purpose of this paper was to evaluate FCR in survivors of Hodgkin's and diffuse large B-cell lymphomas, given a high rate of survivorship in this patient population.Research Approach: The parent study was a multi-site, cluster-randomized trial to assess a communication skills intervention: survivorship planning consultation (versus a time-attention control - wellness rehabilitation intervention) to promote transition to survivorship.Participants & Methodological Approach: 199 patients enrolled in the study and completed a survivorship (or control) consultation one-month after receiving the news of their survivorship status; 141 of those patients (n = 92 experimental arm, n = 49 control arm) completed an interview at their 6-month follow-up consultation. In the interview, participants described frequency of FCR, causes of FCR, coping mechanisms, and specific things oncologists said to reduce FCR. Both qualitative and quantitative methods were utilized for analyzing participant responses.Findings: The majority (88%) of participants reported experiencing FCR, with a higher number of participants in the experimental arm significantly more likely to endorse FCR compared to the control group participants. The main causes of FCR were having medical appointments and concerns about potential relapse and secondary cancers. Participants endorsed utilizing self-sufficient coping mechanisms. As well, participants reported that oncologists most frequently cited specific cure rates of lymphoma to reduce patients' FCR.Interpretation & Implications for Psychosocial Providers: Communication skills training programs should emphasize FCR in survivorship consultations.

Maternal functional status is an important health outcome for new mothers. Postpartum wellness includes both feeling "back to self" physically and emotionally, and maternal readiness to perform caretaking tasks. This study sought to identify factors that influence maternal wellness following pregnancy in urban low-income women, in order to identify areas for targeted intervention among this at-risk cohort. We examined the association between depression, self-efficacy, social support, partner support, and sleep with 3 week postpartum physical and emotional wellness. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS ≥10) and the Patient Health Questionnaire (PHQ-9 ≥10). This study includes 379 (of 510 enrolled) mothers, who completed the baseline and 3-week survey (34 days ±13 postpartum). Ninety-seven percent were Black or Hispanic, 53% were born outside of the US, and all were enrolled in Medicaid Managed care. 379 respondents were included. Mothers who did not feel back to self physically and emotionally were more likely to have antepartum complications (47% vs. 34%, p=0.04), were more likely to have a history of depression (29% vs. 15%, p=0.004), less likely to feel supported by their partner (50% vs. 28%, p=0.0006), and less likely to get >5 hours of sleep/night (67% vs. 84%, p=0.002). After controlling for antepartum complications, self-efficacy, social support, partner support, depression at baseline, and sleep, mothers who reported partner support (adjusted OR: 1.2, CI 1.07-1.40) and >5 hours of sleep (adjusted OR: 2.2, CI 1.13-4.4) were more likely to feel physically and emotionally back to self at 3 weeks postpartum. Findings suggest that interventions targeting partner support and sleep may increase mothers' wellness in the early postpartum period, as baseline depression, lack of partner support, and insufficient sleep were risk factors for poor maternal wellness following pregnancy in this population.

Background Survivors of cancer often describe a sense of abandonment after treatment along with heightened uncertainty and limited knowledge of what lies ahead. This study examined the efficacy of a survivorship care plan (SCP) intervention to help physicians to address survivorship issues through communication skills training plus a new consultation focused on the use of an SCP for patients with Hodgkin lymphoma and diffuse large B-cell lymphoma. Methods This 4-site cluster randomized trial examined the efficacy of a survivorship planning consultation (SPC) in patients who achieved complete remission after the completion of first-line therapy (for the SPC, physicians received communication skills training and, using an SCP, applied those skills in a survivorship-focused office visit) versus a control arm in which physicians were trained in and subsequently provided a time-controlled, manualized wellness rehabilitation consultation (WRC) focused only on discussion of healthy nutrition and exercise as rehabilitation after chemotherapy. The primary outcomes for patients were changes in knowledge about lymphoma and adherence to physicians' recommendations for vaccinations and cancer screenings. Results Forty-two physicians and 198 patients participated across the 4 sites. Patients whose physicians were in the SPC arm had greater knowledge about their lymphoma (P = .01) and showed greater adherence to physician recommendations for influenza vaccinations (P = .02) and colonoscopy (P = .02) than patients whose physicians were in the WRC arm. Conclusions A dedicated consultation using an SCP and supported by communication skills training may enhance patients' knowledge and adherence to some health promotion recommendations. (C) 2018 American Cancer Society.

The goal of therapy is typically to improve clients' self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving clients' self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal's Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage physical health problems, we suggest it may also be useful to understand self-management of mental health problems. The Common-Sense Model's strengths-based perspective is a natural fit for the work of counseling psychologists. The model has important practical implications for addressing how clients understand mental health problems over the course of treatment and self-manage these problems during and after treatment.

The present study examines how different chronic illnesses and mental illness comorbidity (chronic illness with complexity [CIC]) associate with components of advance care planning (ACP). We also explore the role self-perceived burden plays in the relationship between illness and ACP. Data were gathered from a cross-sectional survey of 305 elderly participants from the New Jersey End-of-Life study. Participants with diabetes and those with cardiovascular disease (CVD) are less likely, while participants with CIC are more likely, to plan for the end-of-life. Participants with diabetes are less likely to make formal plans, whereas those with CVD are less likely to hold informal discussions. CIC is associated with increased odds of having an advance directive, but no other form of ACP. Self-perceived burden did not appear to be the gateway by which illness groups differentially engaged in ACP. Future research should investigate what aspects of illnesses drive ACP.

The Commonsense Model of Self-Regulation (CSM) has a history of over 50 years as a theoretical framework that explicates the processes by which individuals form cognitive, affective, and behavioral representations of health threats. This article summarizes the major components of individuals' "commonsense models", the underlying assumptions of the CSM as a theory of dynamic behavior change, and the major empirical evidence that have developed these aspects of the CSM since its inception. We also discuss ongoing changes to the theory itself as well as its use in medical practice for optimizing patients' self-management of chronic health threats. The final section focuses on future directions for the theory and its application.

Self-monitoring of blood glucose (SMBG) has been recommended for people with type 2 diabetes mellitus. This trial tested an automated self-management monitor (ASMM) that reminds patients to perform SMBG, provides feedback on results of SMBG, and action tips for improved self-management. This delayed-start trial randomized participants to using the ASMM immediately (IG), or following a delay of 6 months (DG). Glycated hemoglobin (HgbA1c) level and survey data was collected at home visits every 3 months. 44 diabetic men and women, mean age 70, completed the 12-month trial. Baseline HgbA1c was 8.1 % ± 1.0, dropping to 7.3 ± 1.0 by 9 months, with a 3-month lag in the DG (F = 3.56, p = 0.004). Decrease in HgbA1c was significantly correlated to increased frequency of SMBG, R = 0.588, p < 0.01. Providing older diabetics with objective immediate contingent feedback resulted in more frequent SMBG that correlated with better glycemic control. This type of technology may provide real-time feedback not only to patient users, but to the health care system, allowing better integration of provider recommendations with patient-centered action.

IntroductionSurvivors of cancer often describe a sense of abandonment post-treatment, with heightened worry, uncertainty, fear of recurrence and limited understanding of what lies ahead. This study examines the efficacy of a communication skills training (CST) intervention to help physicians address survivorship issues and introduce a new consultation focused on the use of a survivorship care plan for patients with Hodgkin's lymphoma and diffuse large B-cell lymphoma.Methods and analysisSpecifically, this randomised, 4-site trial will test the efficacy of a survivorship planning consultation (physicians receive CST and apply these skills in a new survivorship-focused office visit using a survivorship plan) with patients who have achieved complete remission after completion of first-line therapy versus a control arm in which physicians are trained to subsequently provide a time-controlled, manualised wellness rehabilitation consultation focused only on discussion of healthy nutrition and exercise as rehabilitation postchemotherapy. The primary outcome for physicians will be uptake and usage of communication skills and maintenance of these skills over time. The primary outcome for patients is changes in knowledge about lymphoma and adherence to physicians’ recommendations (eg, pneumococcus and influenza vaccinations); secondary outcomes will include perceptions of the doctor–patient relationship, decreased levels of cancer worry and depression, quality of life changes, satisfaction with care and usage of healthcare. This study will also examine the moderators and mediators of change within our theoretical model derived from Leventhal's Common-Sense Model of health beliefs.Ethics and disseminationThis study was approved by the Institutional Review Boards at Memorial Sloan Kettering Cancer Centers and all other participating sites. This work is funded by the National Cancer Institute (R01 CA 151899 awarded to DWK and SH as coprincipal investigators). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute (NCI) or the National Institutes of Health (NIH). The study findings will be disseminated to the research and medical communities through publication in peer-reviewed journals and through presentations at local, national and international conferences.Trial registration numberNCT01483664.

The majority of U.S. adults do not receive an annual influenza vaccination. Behavioral economics tools can be harnessed to encourage health behaviors. Specifically, scheduling patients by default for a flu shot appointment leads to higher vaccination rates at a medical practice than does merely encouraging flu shot appointments. It is not known, however, whether default appointments actually increase net vaccination or merely displace vaccinations from other venues. In the current field experiment, we examined the use of default appointments in a large medical practice and established that automatically scheduled appointments increased the total vaccination rate by 10 percentage points within the practice without displacing vaccinations that patients would otherwise have received in other settings. This increased vaccination rate came at the cost of a high no-show rate. These findings point to an effective way to increase vaccination rates and may offer a cost-saving measure in the scope of accountable care organizations.