Impact of a Self-Help Intervention on Performance of Headache Management Behaviors: A Self-Efficacy Approach

A Peer Reviewed Publication of the College of Allied Health & Nursing at Nova Southeastern University Dedicated to allied health professional practice and education http://ijahsp.nova.edu Vol. 2 No. 1 ISSN 1540-580X Impact of a Self-Help Intervention on Performance of Headache Management Behaviors: A Self-Efficacy Approach Dale S. Bond, Ph.D.1 Lynne Durrant, Ph.D.2 Kathleen B. Digre, M.D.3 Susan K. Baggaley, A.P.R.N.4 Carla Rubingh, Pharm.D.5 1. 2. 3. 4. 5. VCU Health and Human Performance Laboratory, Virginia Commonwealth University, School of Education, Richmond, VA. Department of Health Promotion and Education, University of Utah, College of Health, Salt Lake City, UT. Department of Neurology, University of Utah Hospital, Salt Lake City, UT. Department of Neurology, University of Utah Hospital, Salt Lake City, UT. University of Utah Hospitals and Clinics, Pain Management Center, Salt Lake City, UT. United States CITATION: Bond, DS., Durrant, L., Digre, KB., Baggaley, SK., Rubingh, C. Impact of a Self-Help Intervention on Performance of Headache Management Behaviors: A Self-Efficacy Approach.The Internet Journal of Allied Health Sciences and Practice. January 2004 . Volume 2 Number 1. ABSTRACT This study evaluated the importance of modeling and performance accomplishment of behavior on enhancing headache management self-efficacy and increasing acquisition and implementation of four headache self-management behaviors: headache diary use, limiting medication overuse, relaxation, and stretching. Primary headache disordered patients (n = 51) were randomly assigned to 3 conditions: self-efficacy videotape treatment (SET; education + modeling and performance of behavior), information-only videotape treatment (IOT; education only), or no-treatment comparison (NTC). The SET group reported higher self-efficacy scores than the NTC at immediate post-treatment. At 1-month follow-up, the SET group reported more headache diary use than the IOT and NCT groups, whereas both the SET and IOT groups reported more frequent performance of the relaxation and stretching behaviors than the NTC group. Despite a smaller sample size, the SET treatment produced a slight increase in headache management self-efficacy immediately after treatment, as well as increased performance of three of the four headache management behaviors at 1-month follow-up. A reduction in self-efficacy following the immediate posttreatment period suggests that multiple treatment exposure may be necessary to effect long-lasting change with respect to self-efficacy, behavioral performance and ultimately changes in headache activity. Although limited in their ability to provide feedback and reinforcement, the potential benefits for patients and health care professionals warrant continued development and study of behavior theory-driven self-help treatment for headache. Future studies should include a larger sample that consists of motivated patients with less severe headache problems who may be more apt to benefit from such theory-driven strategies. INTRODUCTION Headache disorders are chronic, often incapacitating conditions that afflict millions of individuals during their most productive years. Unfortunately, a large proportion of these headache sufferers go undiagnosed or fail to receive adequate treatment.1 Moreover, with increasing health care constraints such as limited patient access, reduced time afforded to see patients, increasing treatment costs, and complex referral processes, it is challenging to make an accurate diagnosis and secure the © The Internet Journal of Allied Health Sciences and Practice, 2004 Impact of a Self-Help Intervention on Performance of Headache Management Behaviors: A Self-Efficacy Approach 2 appropriate level of care for headache sufferers, let alone tackle concomitant psychosocial issues. Thus, headache disorders represent a justifiable target for low-cost interventions that facilitate patients’ adoption of self-management behaviors and involve minimal contact with health care professionals. Behavioral treatments for headache are delivered in either a clinic-based or minimal-therapist-contact treatment (MTCT) format. MTCT treatments teach patients how to help themselves through the use of written, videotape, and computer media formats with only minimal contact from health professionals (e.g., periodic telephone consultations, initial modeling of self-management behaviors, etc.). MTCT headache treatments have largely focused on relaxation, biofeedback, and cognitive techniques.2-4 Research shows that MTCT interventions yield similar or superior results to both equivalent clinic-based treatments and common pharmacological therapies.5,6 In addition, MTCT interventions are on average four to five times more cost-effective than clinicbased treatments.7 “Self-help” interventions go one step farther by attempting to facilitate adoption and maintenance of behaviors without any direct assistance from health professionals. Only a few studies have focused on self-help treatments for headache. Kohlenberg and Cahn compared the effects of self-help written materials, consisting of education about headache types and instructions for biofeedback, relaxation, and cognitive-behavior therapy, with information-only written materials (i.e., a popular book on headache treatment and diagnosis) among 51 migraineurs.8 Post-treatment reductions in headache frequency for the self-help and information-only groups were 62% and 14%, respectively. More recently, headache patients randomized to a 6-week internetbased self-help treatment involving relaxation and problem-solving training reported a 31% average reduction in headache activity after treatment as compared with only a 3% average reduction reported by those patients randomized to a patient control group.9 In both studies, however, ability to generalize the results was hindered by a high attrition rate (50% or more), an inherent limitation of self-help treatments. Self-help behavioral treatments for headache may be more likely to yield successful behavior and clinical outcomes and effecting enduring change when their development is driven by a theory of health behavior change.10 Self-efficacy, a widely studied theoretical construct of health behavior change, has garnered attention as an important determinant in the perception and behavioral management of several chronic pain syndromes such as fibromyalgia,11 low back pain,12 rheumatoid arthritis,13 and headache.14 Self-efficacy refers to the belief or level of confidence in one’s capabilities to successfully execute a course of action or behavior required to produce a desired outcome.15 Research supports the hypothesis that the relationship between self-efficacy and chronic headache pain relief is mediated by active and enduring efforts to prevent and manage pain as well as the alleviation of distress that may exacerbate pain sensations and discomfort.16 Recent studies among chronic headache sufferers hav (...truncated)