Does readiness to change predict subsequent alcohol consumption in medical inpatients with unhealthy alcohol use?

We studied whether readiness to change predicts alcohol consumption (drinks per day) 3 months later in 267 medical inpatients with unhealthy alcohol use. We used 3 readiness to change measures: a 1 to 10 visual analog scale (VAS) and two factors of the Stages of Change Readiness and Treatment Eagerness Scale: Perception of Problems (PP) and Taking Action (TA). Subjects with the highest level of VAS-measured readiness consumed significantly fewer drinks 3 months later [Incidence rate ratio (IRR) and 95% confidence interval (CI): 0.57 (0.36, 0.91) highest vs. lowest tertile]. Greater PP was associated with more drinking [IRR (95%CI): 1.94 (1.02, 3.68) third vs. lowest quartile]. Greater TA scores were associated with less drinking [IRR (95%CI): 0.42 (0.23, 0.78) highest vs. lowest quartile]. Perception of Problems' association with more drinking may reflect severity rather than an aspect of readiness associated with ability to change; high levels of Taking Action appear to predict less drinking. Although assessing readiness to change may have clinical utility, assessing the patient's planned actions may have more predictive value for future improvement in alcohol consumption.

Improvements in readiness to change and drinking in primary care patients with unhealthy alcohol use: a prospective study.

BACKGROUND: The course of alcohol consumption and cognitive dimensions of behavior change (readiness to change, importance of changing and confidence in ability to change) in primary care patients are not well described. The objective of the study was to determine changes in readiness, importance and confidence after a primary care visit, and 6-month improvements in both drinking and cognitive dimensions of behavior change, in patients with unhealthy alcohol use. METHODS: Prospective cohort study of patients with unhealthy alcohol use visiting primary care physicians, with repeated assessments of readiness, importance, and confidence (visual analogue scale (VAS), score range 1-10 points). Improvements 6 months later were defined as no unhealthy alcohol use or any increase in readiness, importance, or confidence. Regression models accounted for clustering by physician and adjusted for demographics, alcohol consumption and related problems, and discussion with the physician about alcohol. RESULTS: From before to immediately after the primary care physician visit, patients (n = 173) had increases in readiness (mean +1.0 point), importance (+0.2), and confidence (+0.5) (all p < 0.002). In adjusted models, discussion with the physician about alcohol was associated with increased readiness (+0.8, p = 0.04). At 6 months, many participants had improvements in drinking or readiness (62%), drinking or importance (58%), or drinking or confidence (56%). CONCLUSION: Readiness, importance and confidence improve in many patients with unhealthy alcohol use immediately after a primary care visit. Six months after a visit, most patients have improvements in either drinking or these cognitive dimensions of behavior change.

Strategic Change Management Readiness Evaluation in Organizations

The objective of this study and paper was to find out how the strategic change management readiness in organizations can be evaluated. Based on theory and prior CMP model, the framework of strategic change management and issues related to it was constructed. Additionally a synthesis of the most important phases and interventions in strategic change process and project was created. These phases were starting point, planning, implementation and evaluation and securing phases. Qualitative approach was utilized in the empirical part of the study due to the need for in-depth information about the topics surveyed through semi-structured interview. There were 18 responders from the top management of large Finnish companies. In this study interventions, strengths and weaknesses during the various phases of strategic change projects were revealed. Additionally the interviewees’ opinion on the importance of each of the interventions in strategic change project success was asked. According to this study, the most important phases recognized through researching theoretical literature, prior CMP model and empirical information in starting point phase were analysis of current and desired state and need for change accompanied with guiding coalition formulation. In planning phase the most important interventions were project organization formulation, action plan creation, analysis of prior and current strategic change projects and organizational structure analysis. In the change project implementation phase the interventions of importance were launch, quick wins, sense of urgency creation, change resistance management and change communications. In the final evaluation and securing phase project evaluation was the most important intervention. Based on the results a tool for creating change management readiness profile was created.

A stress and coping approach to organisational change: Evidence from three field studies

In this paper, a stress and coping perspective is used to outline the processes that determine employee adaptation to organisational change. A theoretical framework that simultaneously considers the effects of event characteristics, situational appraisals, coping strategies, and coping resources is reviewed, Three empirical investigations of organisational change that have tested various components of the model are then presented. In the first study, there was evidence linking event characteristics, situational appraisals, coping strategies and coping resources to levels of employee adjustment in a sample of pilots employed in a newly merged airline company. In a more focused test of the model with a sample of employees experiencing a restructuring process in their Organisation it was found that the provision of change-related information enhanced levels of efficacy to deal with the change process which, in turn, predicted psychological wellbeing, client engagement, and job satisfaction. In a study of managers affected by a new remuneration scheme, there was evidence to suggest that managers who received change-specific information and opportunities to participate in the change process reported higher levels of change readiness. Managers who reported higher levels of readiness for change also reported higher levels of psychological wellbeing and job satisfaction. These studies highlight ways in which managers and change agents can help employees to cope during times of organisational change.

An examination of the antecedents of readiness for fine-tuning and corporate transformation changes

This study examined employee readiness for fine-tuning changes and for corporate transformation changes. It was proposed that employees would report different degrees of readiness for these two types of change and that different variables would be associated with readiness for the two types of change. Results of regression analyses indicated that trust in peers and logistics and system support displayed strong positive relationships with readiness for fine-tuning changes, while trust in senior leaders and self-efficacy displayed strong positive relationships with readiness for corporate transformation changes. The implications of this study focus on the appropriateness of traditional change management strategies in light of findings that multiple change readiness attitudes exist within an organization.

Administering brief motivational interventions to young men: Results from a pilot census transmissible study among 19 year-old francophone Swiss men.

AIMS - To pilot the implementation of brief motivational intervention (BMI) among conscripts, and to test the effectiveness of BMI in young men voluntarily showing up for a single face-to-face alcohol BMI session. Participants were conscripts attending the army recruitment process in Lausanne. This process is mandatory for all Swiss males at age 19 and Lausanne serves all francophone Swiss men. METHODS - Of 3'227 young men that were seen during the army recruitment procedures, 445 voluntarily showed up for a BMI and 367 were included in the study (exclusions were random and unsystematic and related to organizational aspects in the recruitment center). After an initial assessment, subjects were randomized into two groups: an immediate BMI and a 6-month delayed BMI (waiting list design). A 6-month follow-up assessment was conducted in both groups. BMI was a face-to-face 20 minutes counseling session with a psychologist trained in motivational interviewing at baseline and a telephone session for the control group at follow-up. Strategies of BMI included the exploration and evocation of a possible behavior change, importance of future change, readiness to change, and commitment to change. A filmed example of such an intervention is available in French at www.alcoologie.ch. RESULTS - All procedures are now fully implemented and working and the provision of preventive efforts found general approval by the army. 3'227 were eligible for BMI and 445 of them (13.8%) showed up for receiving a BMI. 367 were included in the study, 181 in the BMI group and 186 in the control group. More than 86% of those included were reached at follow-up. With one exception all findings on alcohol use went in the expected direction, i.e. a stronger decrease in alcohol use (or a smaller increase as for usual weekly drinking amount) in the BMI group. The risk for risky single occasion drinking (RSOD) decreased from 57% at-risk users at baseline to 50.6%, i.e. a 6.4% point decrease in the BMI group, while there was only a 0.6% point decrease (from 57.5% to 56.9%) in the control group. Moreover, the study showed that there was a likelihood of crossover effects for other substances like tobacco smoking and cannabis use. Despite these encouraging and consistent positive findings, none reached significance at conventional levels (p < 0.05). DISCUSSION - Data suggest a beneficial impact of BMI on alcohol use outcomes and potential effect on other substance use in 19-year old men attending the army recruitment and showing up voluntarily for BMI. As the main aim was to implement and test feasibility of conducting BMI in this setting none of our findings reached statistical significance. The consistency of findings across measures and substances, however, raises hope that non-significance in the present study does not mean no effect, but mainly insufficient power of this pilot study. [Authors]

Factor structure of the SOCRATES questionnaire in hospitalized medical patients.

The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), a 19-item instrument developed to assess readiness to change alcohol use among individuals presenting for specialized alcohol treatment, has been used in various populations and settings. Its factor structure and concurrent validity has been described for specialized alcohol treatment settings and primary care. The purpose of this study was to determine the factor structure and concurrent validity of the SOCRATES among medical inpatients with unhealthy alcohol use not seeking help for specialized alcohol treatment. The subjects were 337 medical inpatients with unhealthy alcohol use, identified during their hospital stay. Most of them had alcohol dependence (76%). We performed an Alpha Factor Analysis (AFA) and Principal Component Analysis (PCA) of the 19 SOCRATES items, and forced 3 factors and 2 components, in order to replicate findings from Miller and Tonigan (Miller, W. R., & Tonigan, J. S., (1996). Assessing drinkers' motivations for change: The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychology of Addictive Behavior, 10, 81-89.) and Maisto et al. (Maisto, S. A., Conigliaro, J., McNeil, M., Kraemer, K., O'Connor, M., & Kelley, M. E., (1999). Factor structure of the SOCRATES in a sample of primary care patients. Addictive Behavior, 24(6), 879-892.). Our analysis supported the view that the 2 component solution proposed by Maisto et al. (Maisto, S.A., Conigliaro, J., McNeil, M., Kraemer, K., O'Connor, M., & Kelley, M.E., (1999). Factor structure of the SOCRATES in a sample of primary care patients. Addictive Behavior, 24(6), 879-892.) is more appropriate for our data than the 3 factor solution proposed by Miller and Tonigan (Miller, W. R., & Tonigan, J. S., (1996). Assessing drinkers' motivations for change: The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychology of Addictive Behavior, 10, 81-89.). The first component measured Perception of Problems and was more strongly correlated with severity of alcohol-related consequences, presence of alcohol dependence, and alcohol consumption levels (average number of drinks per day and total number of binge drinking days over the past 30 days) compared to the second component measuring Taking Action. Our findings support the view that the SOCRATES is comprised of two important readiness constructs in general medical patients identified by screening.

Yksilön muutokseen suhtautuminen psykologisen omistajuuden näkökulmasta

Työntekijöiden kokema psykologinen omistajuus ja muutokseen suhtautuminen kietoutuvat yhteen tämän tutkimuksen tarkastelussa. Organisaatiot kohtaavat nykypäivänä jatkuvaa muutostarvetta ja työntekijöiden muutokseen suhtautumisella on merkittävä vaikutus muutoshankkeiden onnistuneessa läpiviennissä. Toisaalta työtä kohtaan koetut psykologisen omistajuuden tunteet nähdään merkittävänä työhön ja työn kokemiseen liittyvänä tunteena. Tutkimuksen tavoitteena onkin ymmärtää miten työntekijöiden kokema psykologinen omistajuus ilmenee työntekijöiden muutokseen suhtautumisessa. Tutkimuksen tarkastelu tapahtuu organisatorisessa kontekstissa, merkityksen luomisen viitekehyksessä. Tutkimus suoritettiin fenomenografisena tapaustutkimuksena liiketoiminnan tukipalveluita tarjoavassa asiantuntijaorganisaatiossa. Tutkimuksen lopputuloksen muodostavat neljä erilaista kuvauskategoriaa, jotka kuvaavat kohdeorganisaation työntekijöiden työtään kohtaan kokemia psykologisen omistajuuden tunteita ja sitä kuinka nämä tunteet näyttäytyvät heidän muutokseen suhtautumisessa. Psykologinen omistajuus ja muutokseen suhtautuminen ovat monitahoisia ilmiöitä, joissa yksilön kokemukseen vaikuttavat useat eri tekijät. Psykologista omistajuutta tunteva yksilö on lähtökohtaisesti valmiimpi kohtaamaan muutoksia psykologisen omistajuuden tunteiden ja muutosvalmiuden pohjautuessa monelta osin samoihin tekijöihin. Toisaalta voimakkaat psykologisen omistajuuden tunteet voivat olla yksilöä uuvuttavia, mikä saa muutokset näyttäytymään taakkana myönteisistä aikomuksista huolimatta.

Identificação e análise dos riscos associados ao processo de mudança na implantação de um novo modelo de gestão de operações

Este estudo, por meio de uma pesquisa exploratória, descritiva e explicativa, buscou identificar os riscos associados ao processo de mudança na implantação de um novo modelo de gestão de operações denominado gerenciamento integrado de operações (GIOp), considerando novos processos e tecnologias na área de negócio de E&P da Petrobras. Utilizando como referência o modelo proposto por Kotter (1996), no qual identifica oito passos para a gestão de mudança em uma organização, e com base na aplicação do questionário proposto por Cohen (2005) denominado “The Change Readiness Assessment”, que permite aferir dentro dos oito passos onde estão localizados potenciais riscos e ameaças, este estudo apresenta reflexões sobre as percepções de quatro categorias de trabalho (executivos, gerentes, técnicos e equipe de projeto) da UO-ES, e de que forma impactam na prontidão para a mudança. O estudo trata também da importância do papel fundamental desempenhado por líderes neste processo, que asseguram o patrocínio necessário para a sustentabilidade do projeto. O resultado dos questionários demonstra uma percepção de risco considerável em todas as categorias. O único passo que não foi abrangido na área de risco é o senso de urgência (passo 1), que apresentou baixo risco. Como a mudança não se sustenta somente no passo 1, é importante que se reúnam os indivíduos, no sentido de buscar desenvolver uma avaliação compartilhada das questões relativas ao processo de mudança (problemas, oportunidades) entre os grupos envolvidos, objetivando um clima de confiança e de comunicação acerca do projeto, para assegurar que os resultados sejam atingidos. Nesse contexto, o sentido de urgência serve como força motriz para acelerar e dinamizar os passos seguintes.

Motivation as a predictor of drinking outcomes after residential treatment programs for alcohol dependence

OBJECTIVES: Patients' motivation to change their substance use is usually viewed as a crucial component of successful treatment. The objective of this study was to examine whether motivation contributes to drinking outcomes after residential treatment for alcohol dependence. METHODS: Our sample included 415 Swiss patients from 12 residential alcohol treatment programs. We statistically controlled for important predictors, such as sex, employment, alcohol consumption before admission, severity of alcohol dependence, severity of psychiatric symptoms at admission, and alcohol-related self-efficacy at discharge. Abstinence, alcohol consumption, and time to first drink were used as primary outcome measures and were assessed 1 year after discharge from treatment. RESULTS: Action-oriented motivation to change substance use had a modest impact on drinking outcomes. At the 1-year follow-up, only the Taking Steps subscale of the Stages of Change Readiness and Treatment Eagerness Scale and alcohol-related self-efficacy were found to be significant predictors of abstinence and the number of standard drinks. CONCLUSIONS: The impact of action-oriented motivation at admission to residential treatment is modest but still relevant, compared with other outcome predictors. It may be useful to focus treatment on improving action-oriented motivation to reduce substance use

Predictors of client retention in alternative -to -prison substance abuse programs

Increased treatment retention among substance abusing individuals has been associated with reduced drug use, fewer arrests, and decreased unemployment, as well as a reduction in health risk behaviors. This longitudinal study examined the predictors of client retention for alternative to prison substance abuse treatment programs through assessing the roles of motivational factors and the client-worker relationship. The sample was comprised of 141 male felony offenders who were legally mandated to community based long-term residential drug treatment programs. ^ The primary measures used in the study were the consecutive days a participant remained in treatment, Stages of Change Readiness Model and Treatment Eagerness Scale (SOCRATES), the Working Alliance Inventory (WAI), and The Readiness Ruler. Hierarchical multiple regression analysis was conducted for four hypotheses (a) participants who are more motivated to change at the time of entry will remain in treatment longer, (b) participants who have a strong therapeutic alliance will remain in treatment a greater number of consecutive days than participants who have weaker therapeutic alliance, (c) motivation to change, as measured at treatment entry, will be positively related to therapeutic alliance, (d) during the course of treatment variation in motivation to change will be predicted by the therapeutic alliance. ^ Results support the following conclusions: Among clients in alternative-to prison programs the number of days in treatment is positively related to their motivation to change. The therapeutic alliance is not a predictor of the number of days in treatment. Motivation to change, particularly recognition of a drug problem, is positively related to the therapeutic alliance. Changes in motivation to change in response to treatment are positively related to the therapeutic alliance among clients in an alternative to prison substance abuse treatment programs. These results carry forward prior research and have implications for social work practice, research, and social welfare policy. ^

Predictors of client retention in alternative to prison substance abuse programs

Increased treatment retention among substance abusing individuals has been associated with reduced drug use, fewer arrests, and decreased unemployment, as well as a reduction in health risk behaviors. This longitudinal study examined the predictors of client retention for alternative to prison substance abuse treatment programs through assessing the roles of motivational factors and the client-worker relationship. The sample was comprised of 141 male felony offenders who were legally mandated to community based long-term residential drug treatment programs. The primary measures used in the study were the consecutive days a participant remained in treatment, Stages of Change Readiness Model and Treatment Eagerness Scale (SOCRATES), the Working Alliance Inventory (WAI), and The Readiness Ruler. Hierarchical multiple regression analysis was conducted for four hypotheses (a) participants who are more motivated to change at the time of entry will remain in treatment longer, (b) participants who have a strong therapeutic alliance will remain in treatment a greater number of consecutive days than participants who have weaker therapeutic alliance, (c) motivation to change, as measured at treatment entry, will be positively related to therapeutic alliance, (d) during the course of treatment variation in motivation to change will be predicted by the therapeutic alliance. Results support the following conclusions: Among clients in alternative-to prison programs the number of days in treatment is positively related to their motivation to change. The therapeutic alliance is not a predictor of the number of days in treatment. Motivation to change, particularly recognition of a drug problem, is positively related to the therapeutic alliance. Changes in motivation to change in response to treatment are positively related to the therapeutic alliance among clients in an alternative to prison substance abuse treatment programs. These results carry forward prior research and have implications for social work practice, research, and social welfare policy.

Postawy pracowników wobec zmiany organizacyjnej. Analiza socjologiczna na przykładzie przedsiębiorstw przechodzących procesy transformacyjne

Wydział Nauk Społecznych: Instytut Socjologii