Transtheoretical model technology-based interventions to improve health behaviors in veterans.

The Transtheoretical Model of Health Behavior Change (TTM) is a leading theoretical framework of motivation for healthful lifestyle modification and has been employed nationally and internationally within the civilian sector for decades. The TTM has demonstrated effectiveness in reducing the public health burden related to various chronic diseases that are largely preventable through successful health behavior change intervention. Because the VA healthcare system (VA) is committed to providing quality care to Veterans who, all too often, suffer from complex physical and psychological comorbidities, it is critical to reduce Veterans' unhealthy behaviors while also helping them adopt and sustain adaptive health behaviors. TTM interventions are typically delivered remotely via computer or mobile devices using Expert Systems (ES) programs (TTM-ES). As such, TTM-ES offers the VA an opportunity to access a larger number of Veterans and provide a variety of care choices that can fit into their personal life context. While the VA already utilizes numerous computer- based behavior change applications for a variety of psychological and physical health conditions, the TTM-ES is comprised of unique characteristics that keeps it at the forefront of effective health behavior change interventions. TTM-ES, now referred to as computer tailored interventions (CTIs), are individually tailored for each Veteran, based on initial and ongoing assessment of their degree of motivation for change, and utilizes evidence- based algorithms to provide the Veteran with feedback to synergistically move them toward health behavior modification. Further development, testing, implementation and dissemination of the TTM framework and TTM-CTIs for Veterans are discussed.