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Predicting treatment course and outcome using a promotion and prevention framework in a community sample of arthritis sufferers

Authors Blalock DV, McKnight PE, Kashdan TB, Franz SC

Received 30 December 2017

Accepted for publication 8 March 2018

Published 7 June 2018 Volume 2018:12 Pages 981—991


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen

Dan V Blalock,1,2 Patrick E McKnight,3 Todd B Kashdan,3 Simone C Franz3,4

1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; 3Department of Psychology, George Mason University, Fairfax, VA, USA; 4Humanproof, LLC, Arlington, VA, USA

Objective: The present study examined the proposition that patients need to focus on something beyond simply “getting better”. In a sample of arthritis sufferers, we distinguished individuals by the goals that motivated them – moving toward aspirational goals and maximizing gains (promotion focus) rather than obligations and minimizing losses (prevention focus) – and how these motivational styles influenced treatment.
Methods: Patients (N=254) participated in a randomized controlled trial of resistance training and self-management, providing 6 time points of data over 2 years. Promotion and prevention focus at baseline were used to predict the course (compliance and changes in coping self-efficacy) and outcome (changes in physical functioning) of treatment.
Results: Arthritis sufferers with strong promotion orientations showed significant improvements in physical functioning (a direct positive impact on physical health); there were no significant associations with treatment compliance and coping self-efficacy. Arthritis sufferers with strong prevention orientations complied less with the treatment and showed little change in coping self-efficacy during treatment, which, in turn, predicted worse physical functioning over time (a pernicious, indirect influence on treatment outcome).
Conclusion: A focus on positive approach-oriented goals may improve overall treatment response, whereas a focus on negative avoidance-oriented goals may degrade treatment response through reduced compliance and self-efficacy.

Keywords: treatment, promotion and prevention, self-efficacy, physical functioning, arthritis

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