Rationale:

The cardiac rehabilitation environment presents an ideal opportunity to provide patients with health behavior change counseling beyond brochures and a one-size-fits-all methodology. The Fairview Health System in Minneapolis, Minnesota has implemented a system-wide initiative of staff training and clinical intervention based on Prochaska's Transtheoretical Model within its cardiac rehabilitation program.

Methods:

Staff training was conducted by a psychotherapist with a specialty in the Transtheoretical Model and health behavior change. Training consisted of classroom education on the use of the model and observation during real interventions. Patients were assessed using the model at the beginning and end of their cardiac rehabilitation treatment for the following behaviors: aerobic exercise, physical activity, low fat eating, smoking cessation and stress management. A standardized set of questions was asked to properly identify the stage of change. Interventions included staged-matched counseling techniques within all points of contact, including education materials, group education sessions, individual sessions, assessment and discharge conversations and during monitored exercise.

Results:

462 patients were followed in 2004 for the low fat eating behavior. Of these patients, 24% were in the action stage at baseline, and 87% were in the action stage at the completion of the program. When assessing the behavior of aerobic exercise, 14% were in the action stage at baseline, and 84% were in the action stage at the completion of the program.

Conclusions:

Results suggest that the Transtheoretical Model improves outcomes in a cardiac rehabilitation environment during a six-week intervention. A three-month follow-up session is currently being implemented to determine whether these effects continue after the conclusion of the standard six-week cardiac rehabilitation program.