Our Publications

Publications and other information offered here are meant to keep the public abreast of new developments in the field of health behaviour change intervention, and share knowledge with students, experts, and practitioners about evidence-based interventions and methods used in intervention design and evaluation.

See below for publications authored by Can-Change members or browse “Other Relevant Publications” from the field of behavioural medicine.

Please note that articles are posted in the language in which they were originally published.

February 18, 2022

Training Physicians in Motivational Communication to Address Influenza Vaccine Hesitation: A Proof-of-Concept Study

Members of Can-Change A. Dragomir, V. Gosselin-Boucher, C. Laurin, K. Lavoie, and S. Bacon are seeking strategies to support health care professionals on how to address vaccine hesitancy are needed. They developed a 4-h Motivational Communication (MC) training program tailored to help physicians address hesitancy related to influenza vaccination among patients living with rheumatoid arthritis. The program increased MC competency among rheumatology physicians and promoted behavioral change among patients.
January 18, 2022

Weight gain, weight management and medical care for individuals living with overweight and obesity during the COVID-19 pandemic (EPOCH Study)

Can-Change member M. Vallis co-authors a paper on the EPOCH study whose results suggest that the COVID-19 pandemic negatively impacted patient care for those living with overweight and obesity and was associated with weight gain and interfered with weight management strategies.
December 22, 2021

Ending the Pandemic: How Behavioural Science Can Help Optimize Global COVID-19 Vaccine Uptake

Can-Change members Michael Vallis, Simon Bacon, Kim Corace, Justin Presseau, Joshua Rash, and Kim Lavoie and colleagues presents a behavioural sciences framework to promote vaccine acceptance with a model that underlines the need to understand context-specific barriers to vaccine acceptance and uptake. vaccine development, distribution and promotion have not been sufficient to ensure maximum vaccine uptake.
August 20, 2020

Rethinking How to Expand the Evidence Base for Health Behavior Change in Cardiovascular Disease Prevention

Can-Change executive members K. Lavoie, S. Bacon and T.S. Campbell are leading a study to examine a tailored, technology-supported intervention aimed at increasing physical activity in healthcare professionals. The study will evaluate if additional theory-based behaviour change techniques used to promote motivation, self-regulation and habit can support increased physical activity participation relative to information alone.
July 1, 2020

Asthma and COPD patients’ perceived link between health literacy core domains and self-management of their condition

Health literacy (HL) is a person's ability to practically apply a wide range of cognitive and non-cognitive skills, to make health-related decisions. This study, that involved Can-Change Chair Dr. Kim Lavoie, endeavored to develop a comprehensive, function-based tool that adequately and accurately measures HL skills of this patient population. Involvement of patients from initial stage allowed us to develop a tool that will serve as a first ever developed HL tool for asthma and COPD patient group.
June 21, 2020

The LISA randomized trial of a weight loss intervention in postmenopausal breast cancer

This study, co-authored by Can-Change member Dr. Michael Vallis, investigated whether a standardized, telephone-based weight loss lifestyle intervention in the adjuvant setting would impact BC outcomes.
May 25, 2020

Impact of cognitive-behavioral interventions on weight loss and psychological outcomes: A meta-analysis

This study, which involved Can-Change members Dr. Kim Lavoie, Dr. Catherine Laurin and Dr. Simon Bacon, sought to examine the effects of cognitive-behavioral therapy weight loss (CBTWL) interventions on weight loss and psychological outcomes in adults with overweight or obesity. Whereas current evidence suggests that CBTWL is an efficacious therapy for increasing cognitive restraint and reducing emotional eating, CBTWL does not seem to be superior to other interventions for decreasing depressive symptoms.
May 24, 2020

Evaluation of Communication Skills Among Physicians: A Systematic Review of Existing Assessment Tools

The importance of physician training in communication skills for motivating patients to adopt a healthy life-style and optimize clinical outcomes is increasingly recognized. This study, led by Can-Change trainee Vincent Gosselin Boucher, inventoried and systematically reviewed the psychometric properties of, and the skills assessed by, existing assessment tools used to evaluate communication skills among physicians.
May 1, 2020

Bridging the intention-behavior gap for cardiac rehabilitation participation: the role of perceived barriers

This study, co-authored by Can-Change members Dr. Codie Rouleau and Dr. Tavis Campbell, explored whether well-documented cardiac rehabilitation barriers (e.g., comorbidities, logistical/time constraints, and low social support) moderate the association between intention to participate and actual program enrollment and attendance. Assessing and addressing perceived barriers during the transition to cardiac rehabilitation, even when patients present as highly motivated to attend, may be critical to promoting program uptake.
March 24, 2020

An international Delphi consensus study to define motivational communication in the context of developing a training program for physicians

Training physicians to improve their behavior change counseling/communication skills is important, yet the evidence for the efficacy and acceptability of existing training programs is lacking and there is little consensus on the core competencies that physicians should master in the context of NCD management. The purpose of this study, led by a number of Can-Change members including Anda Dragomir, Vincent Gosselin Boucher and Drs Simon Bacon and Kim Lavoie, is to generate an acceptable, evidence-based, stakeholder-informed list of the core communication competencies that physicians should master in the context of NCD management.
January 24, 2020

Training physicians in behavioural change counseling: A systematic review

Physician training in evidence-based behaviour change counselling (BCC) may improve behavioural risk factor management through prescriptive behaviour change interventions employed by physicians. The objectives of this systematic review, led by Can-Change trainees Anda Dragomir and Cassandre Julien, was to gauge the efficacy of BCC training programs for physicians, and to describe program content, dose and structure to inform better design and dissemination.
December 10, 2019

Uptake of best practice recommendations in the management of patients with diabetes and periodontitis: a cross- sectional survey of healthcare professionals in primary care

This study, authored by Can-Change member Dr. Justin Presseau, investigates the practices of healthcare professionals in relation to best practice recommendations for the multidisciplinary management of people with diabetes and periodontitis, focusing on two clinical behaviours: informing patients about the links between diabetes and periodontitis, and suggesting patients with poorly controlled diabetes go for a dental check-up. While knowledge of the evidence is important, future guidelines should consider different strategies to enable implementation of the delivery of healthcare interventions as healthcare professionals currently report low levels of informing patients with diabetes about the links between diabetes and periodontitis.
December 9, 2019

Influencing duration of antibiotic therapy: A behavior change analysis in long-term care

This study, co-authored by Can-Change member Dr. Gary Garber, sought to identify potential antibiotic stewardship opportunities aimed at prolonged duration of antibiotic therapy by examining barriers and enablers to using shorter courses of antibiotic therapy in the long-term care (LTC) setting. The themes identified that influence duration of antibiotic therapy in LTC were environmental context and resources, knowledge, beliefs about consequences, social influences, and behavioral regulation. Tackling misconceptions and providing educational support may be helpful approaches.
September 26, 2019

Integrating Science, Practice, and Mentorship in Cardiac Rehabilitation: THE INAUGURAL TOTALCARDIOLOGY® RESEARCH NETWORK RETREAT

This commentary, authored by a team of researchers including Can-Change members Dr. Codie Rouleau and Dr. Tavis Campbell, provides a model for cardiac rehabilitation centers that provide patient care to meaningfully contribute to our scientific understanding of this lifestyle intervention, with limited extramural research funding. Collaborations with academic partners with expertise in CV research and top-down support from TCR management are key components.
September 10, 2019

Developing Behavior ChangeInterventions for Self-Managementin Chronic Illness

This article, authored by Can-Change member Dr. Justin Presseau, reviews key contemporary approaches to intervention development, provide a critical overview, and integrate these approaches into a pragmatic, user-friendly framework to rigorously guide decision-making in behavior change intervention development.
August 25, 2019

Guided asthma self-management or patient self-adjustment? Using patients’ narratives to better understand adherence to asthma treatment

This study, co-led by Can-Change members Dr. Kim Lavoie and Dr. Simon Bacon, aimed to better understand patients’ perspective of asthma self-management by focusing on the sociocultural and medical context shaping patients’ illness representations and individual decisions. Data suggest that while physicians contribute to shaping patients’ beliefs and perceptions about the disease and treatment goals, patients tend to listen to their own experience and manage the disease accordingly
June 22, 2019

Group-based, person-centered diabetes self-management education: healthcare professionals’ implementation of new approaches

In the field of diabetes education, many healthcare professionals favour person-centeredness as a concept, but implementation in practice remains challenging. Programs have often a fixed curriculum dominated by biomedical issues. Person-centeredness in group-based programs requires a change in practice towards addressing biopsychosocial issues and facilitating group processes. The objective of this study, in which Can-Change member Dr. Michael Vallis participated, was to explore how healthcare professionals implement new approaches to facilitate group-based, person-centered diabetes education targeting people with type 2 diabetes.
May 9, 2019

Behavioural interventions targeting physical activity improve psychocognitive outcomes in COPD

This study, led by Can-Change Chair Dr. Kim Lavoie, explored the impact of a self-management behaviour modification (SMBM) programme with/without bronchodilators and with/without exercise training (ExT) to improve daily physical activity on psychological and cognitive outcomes in COPD patients as a secondary analysis of the PHYSACTO trial. Anxiety reduced with increased physical activity, cognitive function improved with increased exercise capacity, and depression reduced with increases in either physical activity or exercise capacity. Interventions that increase daily physical activity or exercise capacity may improve psychological and cognitive outcomes in COPD.
December 27, 2018

Applying Precision Medicine to Healthy Living for the Prevention and Treatment of Cardiovascular Disease

This review, involving Can-Change members Dr. Tavis Campbell and Dr. Codie Rouleau, will highlight the importance of healthy living medicine (HLM) directed toward the prevention and treatment of chronic diseases in the context of precision medicine. Traditionally, HLM, particularly when practiced in the context of physical activity and diet, is commonly viewed as an all-or-none and one-size-fits-all paradigm. Patients achieving target levels of physical activity and diet is certainly favourable, but healthy living practices at levels below current guidelines portend significant health benefits.
November 24, 2018

The evaluation of a brief motivational intervention to promote intention to participate in cardiac rehabilitation: A randomized controlled trial

This study, led by Can-Change member Codie Rouleau, investigated the impact of motivational interviewing on intention to participate in cardiac rehabilitation (CR) and found that a single collaborative conversation about CR can increase both intention to attend CR and actual program adherence.
November 23, 2018

Feasibility and usability of an ontology-based mobile intervention for patients with hypertension

Mobile health interventions offer unique advantages and novel approaches to helping individuals manage hypertension. However, current interventions often lack theoretical and scientific grounding. The goal of this study, in which Can-Change member Dr. Michael Vallis took part, is to effectively model the knowledge, concepts and relationships relevant to the management of a chronic illness like hypertension, and to implement this knowledge model within a mobile self-management application that can be used by patients. The study concludes that it is possible to model existing information about the management of hypertension as an ontology. Given the nature of ontological models, this approach can be easily modified to address a variety of... Continue reading"Feasibility and usability of an ontology-based mobile intervention for patients with hypertension"
October 22, 2018

Curbing excess gestational weight gain in primary care: using a point-of-care tool based on behavior change theory

Excess gestational weight gain (GWG) is a risk factor for several adverse outcomes for mothers and their offspring. The 5As of Healthy Pregnancy Weight Gain is a tool that assists clinicians to have patient-centered discussions about GWG. This feasibility trial, co-led by Can-Change member Dr. Michael Vallis, examined the association between training in the use of this tool and women’s self-efficacy to manage GWG, readiness to adhere to GWG guidelines, perception of their clinicians’ patient-centeredness when discussing GWG, and guideline concordance of total GWG.
April 27, 2018

Assessing the Value of Moving More-The Integral Role of Qualified Health Professionals

Given the importance of including more steps and less sitting in a patient's physical activity routine, health care professionals must develop enhanced skills for prescribing and guiding individualized movement programs for all their patients. The ability to appropriately assess risk before advising an individual to move more is integral to clinical decision-making. This perspectives article, co-authored by Can-Change members Dr. Tavis Campbell and Dr. Codie Rouleau, clarifies key issues related to prescribing movement as medicine and presents a new process for clinical assessment.
April 18, 2018

Diabetes-Related Behavior Change Knowledge Transfer to Primary Care Practitioners and Patients: Implementation and Evaluation of a Digital Health Platform

The aim of this study, led in part by Can-Change member Dr. Michael Vallis, was to develop and evaluate a computerized decision support platform that assists primary care practitioners in applying standardized behavior change strategies and clinical practice guidelines–based recommendations to an individual patient and empower the patient with the skills and knowledge required to self-manage their diabetes through planned, personalized, and pervasive behavior change strategies.
February 1, 2018

A qualitative study exploring factors that influence enrollment in outpatient cardiac rehabilitation

This study, co-authored by Can-Change members Dr. Codie Rouleau and Dr. Tavis Campbell, explored patients' decision-making about whether or not to enroll in cardiac rehabilitation (CR), an underutilized program that is associated with significantly improved health outcomes. Themes that emerged included anticipated benefit, perceived ability, and contextual influences. Individualized efforts to resolve ambivalence, address knowledge gaps, and problem-solve barriers may increase uptake into CR programs.
July 6, 2017

A Qualitative Study Exploring Factors that Influence Enrolment in Outpatient Cardiac Rehabilitation

Can-Change members C.R. Rouleau and T.S. Campbell were involved in a study exploring patients' decision-making about enrolling into a cardiac rehabilitation program. Anticipated benefit, perceived ability, and contextual influences were themes that emerged from the face-to-face interviews with patients. Individualized efforts to resolve ambivalence, address knowledge gaps, and problem-solve barriers may increase patients' uptake of cardiac rehabilitation programs as effective secondary prevention strategy.
March 8, 2017

“It is not the diet; it is the mental part we need help with.”A multilevelanalysis of psychological, emotional, and social well-being in obesity

This research, in which Can-Change member Dr. Michael Vallis participated, explored the psychological, emotional, and social experiences of individuals living with obesity, and perceptions of health care providers. A theoretical thematic analysis was conducted using two theoretical frameworks applied to transcripts from a previous qualitative study.
November 4, 2016

Behaviour-change intervention in a multicentre, randomised, placebo-controlled COPD study: methodological considerations and implementation

Chronic obstructive pulmonary disease is generally progressive and associated with reduced physical activity. Both pharmacological therapy and exercise training are often not sufficient to change the amount of daily physical activity a patient undertakes. Behaviour-change self-management programmes are designed to address this, including setting motivational goals and providing social support. Can-Change member Dr. Kim Lavoie and colleagues present and discuss the necessary methodological considerations when integrating behaviour-change interventions into a multicentre study.
November 4, 2016

The OPTIMIZE trial: Rationale and design of a randomized controlled trial of motivational enhancement therapy to improve adherence to statin medication

Can-Change members Drs. Kim Lavoie and Tavis Campbell contributed to this manuscript which describes the rational and design of a randomized controlled trial testing the efficacy of motivational interviewing (MInt) in improving adherence to statin medication. The primary outcome is change in MPR adherence to statin medication from baseline to 12-months. Secondary outcomes include within-patient change in self-reported medication adherence, stage of change and self-efficacy for medication adherence, motivation to adhere to statin medication, and lipid profile.
November 4, 2016

Enablers of Physician Prescription of a Long-Term Asthma Controller in Patients with Persistent Asthma

This study aimed to identify key enablers of physician prescription of a long-term controller in patients with persistent asthma. We concluded that tools and training to improve physician knowledge, skills, and perception towards long-term ICS and resources that increase patient adherence and physician comfort to facilitate long-term ICS prescription should be considered as targets for implementation. Can-Change members Dr Kim Lavoie and Dr. Simon Bacon contributed to this article.
November 4, 2016

How can adherence to asthma medication be enhanced? Triangulation of key asthma stakeholders’ perspectives

This study aimed to understand how patients' long-term asthma controller medication adherence may be improved and facilitated by comparing key asthma stakeholders' perspectives. Can-Change members Dr. Kim Lavoie and Dr. Simon Bacon contributed to this article.
November 4, 2016

Changing Provider Behavior in the Context of Chronic Disease Management: Focus on Clinical Inertia

Despite overwhelming evidence supporting the benefits of using clinical practice guidelines, there is a long history of poor uptake by providers (known as "clinical inertia"). This article reviews evidence for the ubiquity of clinical inertia across a variety of chronic health conditions, as well as the organizational and system, patient, and provider factors that serve to maintain it. Can-Change members Dr. Kim Lavoie and Dr. Tavis Campbell contributed to this article.
July 7, 2016

L’entretien motivationnel et les changements de comportements en santé

L'entretien motivationnelle consiste à encourager le patient à exprimer ou à verbaliser son ambivalence face au changement de comportements afin de la résoudre à l’aide de stratégies motivationnelles et cognitivo-comportementales. Cet article, auquel deux membres du Can-Change (Dre Kim Lavoie et Dre Catherine Laurin) décrit les bases théoriques de l’entretien motivationnel (EM) et les applications pratiques de cette approche.
July 7, 2016

Effects of pulmonary rehabilitation on quality of life in chronic obstructive pulmonary disease patients

Pulmonary rehabilitation plays a key role in the management of chronic obstructive pulmonary disease (COPD). This review, authored in part by Can-Change members Dr. Kim Lavoie and Dr. Catherine Laurin describes the state of knowledge over the past year concerning HRQoL benefits after pulmonary rehabilitation and suggests avenues for future research.
December 13, 2015

Comment on Pladevall et al’s 2015 publication in The Diabetes Educator

Comment calling attention to the need for health professionals to be trained in motivational interviewing (MI) due to it being a highly complex clinical skill taking considerable time to learn and master and how health professionals trained in MI also require ongoing training and supervision. Can-Change members Dr. Tavis Campbell, Dr. Simon Bacon, Dr. Kim Corace, Dr. Kim L. Lavoie, and Dr. Michael Vallis contributed to this article.
December 7, 2015

Adherence to Antihypertensive Medications: Current Status and Future Directions

Despite the proven clinical efficacy of antihypertensive medications to control BP, approximately half of treated patients are nonadherent. Barriers to antihypertensive medication adherence are numerous and include patient-related, provider-related, therapy-related, and system-related influences. This review, authored in part by Can-Change members Dr. Kim Lavoie and Dr. Tavis Campbell summarizes the current understanding of the prevalence and impact of the failure to adhere to the medical management of hypertension. Factors linked to improved adherence and studies that assessed strategies to improve adherence are also summarized.
December 7, 2015

Comprehensive Self-Management Strategies

Review of the literature on self-management interventions and giving thought to how, when, and by whom they should be offered to patients. Proper self-management support is a basic prerequisite and self-management interventions need to target enhancing intrinsic motivation to change through client-centered communication (motivational communication). To be able to design and implement self-management interventions that are integrated, coherent, and have a strong likelihood of success, a more careful look is needed at the case manager, the patient (patient evaluation), and the quality assurance. Can-Change member Dr. Kim Lavoie contributed to this article.
December 7, 2015

Training Healthcare Providers in Motivational Communication: Do We Know What We Are Doing?

Regular physical activity (PA) is essential for secondary and tertiary prevention of cardiometabolic risk factors and disease, but low adherence to PA recommendations is common. Motivational communication (MC) shows promise for promoting PA adherence. However dissemination of MC strategies has been limited. We discuss preliminary considerations for training individuals in the use of MC. Future work is needed to establish what constitutes competent MC training to impact cardiometabolic health outcomes. Can-Change members Dr. Tavis Campbell, Dr. Simon Bacon, Dr. Kim Corace, Dr. Kim L. Lavoie, and Dr. Michael Vallis contributed to this article.
December 1, 2015

The Comparative Impact of Mindfulness-Based Cancer Recovery (MBCR) and Cognitive Behavior Therapy for Insomnia (CBT-I) on Sleep and Mindfulness in Cancer Patients

This study, co-authored by Can-Change members Dr. Codie Rouleau and Dr. Tavis Campbell, is a secondary analysis of a randomized controlled trial comparing mindfulness-based cancer recovery (MBCR) to cognitive behavior therapy for insomnia (CBT-I) in cancer patients with insomnia. Changes in dysfunctional sleep beliefs produced by the CBT-I group exceeded those produced by MBCR at post-program and follow-up (P < .001), supporting the use of both CBT-I and MBCR to reduce insomnia severity.
August 11, 2015

Establishing a Working Alliance to Achieve Self-Management Support

It has long been accepted within applied psychology that the quality of the client-therapist relationship —termed the working alliance— is of central importance to treatment outcome and may account for a significant degree of the overall treatment effect. This paper examines the role of the working alliance in diabetes care and offers a practical guide to the diabetes healthcare provider in establishing a working alliance with the person with diabetes in managing diabetes. Can-Change member Dr. Michael Vallis contributed to this article.
August 11, 2015

Psychosocial Intervention for Diabetes Self-Management

The purpose of this research, which included the contributions of Can-Change member Dr. Michael Vallis, is to develop a brief psychosocial intervention protocol for type 2 diabetes self-management and pilot-test its implementation through a 6-session evidence-based psychosocial intervention protocol focusing on the role of behaviour modification, maintenance of motivation and emotion management in type 2 diabetes self-management. This promising intervention could be developed as a training manual to deliver the intervention and fulfill the Canadian Diabetes Association’s clinical guidelines to provide psychosocial interventions as part of diabetes care.
August 11, 2015

A Practical Guide for Diabetes Care Providers

Ambivalence is the psychological state in which a person experiences inconsistent drives; both toward and away from the recommended behaviour. In this paper we demonstrate that hypoglycaemia is a fear event and is likely to elicit strong drives to avoid future hypoglycaemia as a fear coping strategy. The purpose of this paper, authored in part by Can-Change member Dr. Michael Vallis, is to review the evidence on the psychological consequences of hypoglycaemia and to outline fear management strategies that can be implemented by diabetes care providers.
August 11, 2015

Challenges to Self-Management Support in Chronic Diseases

The purpose of this perspective, authored by Can-Change member Dr. Michael Vallis. is to identify a potential limitation in existing self-management support initiatives, namely that true self-management support might require changes by healthcare providers.
August 11, 2015

Behaviour Change Counselling Scale (BCCS)

Behaviour change counselling skills to guide lifestyle interventions can be operationalized and assessed in a reliable and valid manner. As discussed in this article by Can-Change member Dr. Michael Vallis, the BCCS can be used to guide clinical training in lifestyle counselling by operationalizing the component skills and providing feedback on skill achieved.
July 30, 2015

The LISA Trial

Obesity is associated with poor outcomes in women with operable breast cancer. Lifestyle interventions (LIs) that help women reduce their weight may improve outcomes. A telephone-based LI led to significant weight loss that was still evident at 24 months, without adverse effects on QOL, hospitalizations, or medical events. Can-Change member Dr. Michael Vallis contributed to this article.
June 1, 2015

The impact of mindfulness-based interventions on symptom burden, positive psychological outcomes, and biomarkers in cancer patients

This descriptive review, led by Can-Change member Dr. Codie Rouleau, highlights three categories of outcomes that have been evaluated in mindfulness-based intervention (MBI) research with cancer patients. It also examines the clinical relevance of each targeted outcome. Accumulating evidence suggests that participation in a MBI contributes to reductions in psychological distress, sleep disturbance, and fatigue, and promotes personal growth in areas such as quality of life and spirituality. MBIs may also influence markers of immune function, hypothalamic–pituitary–adrenal axis regulation, and autonomic nervous system activity, though it remains unclear whether these biological changes translate to clinically important health benefits.