Prochaska James O
Cancer Prevention Research Center, 2 Chafee Road, University of Rhode Island, Kingston, RI 02881, USA.
Prev Med. 2008 Mar;46(3):281-5. doi: 10.1016/j.ypmed.2008.01.015. Epub 2008 Feb 7.
Given the disease and cost burdens, Multiple Health Behavior Research represents the future of preventive medicine. Growing evidence in this special issue and beyond indicates that simultaneous and sequential interventions can be effective. The challenge for the future is to make such interventions more effective, cost effective and less demanding. Co-variation represents one innovative approach in which effective change on one treated behavior increases the odds of effective action on a second targeted behavior. Co-variation can occur when all behaviors received full treatment, when one receives full treatment and the others receive minimal treatment and when only one behavior is treated and others co-vary without treatment. Integrative treatments represent another innovation in which higher order constructs drive change on multiple behaviors related to the construct and treatment has to be only on one higher order behavior. A more integrated approach to research and practice involves new paradigms complementing established paradigms. Multiple behaviors proactively treated in populations at home or work by computer-based and stage-based interventions designed to generate co-variation that produces greater impacts can complement traditional paradigms that treat single behaviors in individual patients in clinics by clinicians with action-oriented modular interventions designed for specific behaviors to produce significant efficacy. More inclusive research to support more inclusive practices can hopefully lead to more inclusive care.
鉴于疾病和成本负担，多种健康行为研究代表了预防医学的未来。本期特刊及其他研究中越来越多的证据表明，同时进行和相继进行的干预措施可能是有效的。未来的挑战是使这些干预措施更有效、更具成本效益且要求更低。共变是一种创新方法，其中对一种受治疗行为的有效改变会增加对第二种目标行为采取有效行动的几率。当所有行为都接受全面治疗、一种行为接受全面治疗而其他行为接受最少治疗以及仅一种行为接受治疗而其他行为未经治疗却产生共变时，都会出现共变情况。综合治疗是另一项创新，其中高阶结构推动与该结构相关的多种行为发生改变，且治疗只需针对一种高阶行为。一种更综合的研究与实践方法涉及新范式对既定范式的补充。通过基于计算机和阶段的干预措施在家庭或工作场所的人群中对多种行为进行主动治疗，旨在产生能产生更大影响的共变，这可以补充传统范式，即临床医生在诊所通过针对特定行为设计的面向行动的模块化干预措施来治疗个体患者的单一行为以产生显著疗效。开展更具包容性的研究以支持更具包容性的实践有望带来更具包容性的护理。
