Associations of Decisional Balance, Processes of Change, and Self-Efficacy with Stages of Change for Increased Fruit and Vegetable Intake among Low-Income, African-American Mothers

Abstract

Objective To determine the relationship between stage of change and decisional balance, processes of change, and self-efficacy variables of the Transtheoretical Model to increase fruit and vegetable consumption by low-income, African-American mothers, and to assess the usefulness of the model for intervention efforts. Design We used a cross-sectional questionnaire design with a food frequency questionnaire and a staging algorithm to classify women by stage of change before enrollment. We used scaled questionnaire items based on think-aloud data to measure self-efficacy, processes of change, and pros and cons to increasing fruit and vegetable intake and variety. Subjects/setting We recruited a convenience sample of low-income, African-American mothers (n=420) aged 18 to 45 years with children <12 years of age to complete questionnaires at community-based sites. Statistical Analyses Performed Analysis of variance, principal component analysis, χ 2 tests, correlation, and regression analyses were conducted. Results Perceptions of benefits for health and planning meals were stronger for women in later stages compared with earlier stages. The same relationship was observed for the use of processes of change related to becoming aware of health benefits and engaging in enabling behaviors, and variety of fruits and vegetables consumed. Self-efficacy based on eating fruits and vegetables for various eating occasions and in difficult situations was greater for women in later stages compared to earlier stages. Conclusions Interventions for women in earlier stages should include making women aware of health benefits, increasing self-efficacy, and improving ability to make plans and engage in behaviors to increase intake.