Later Stages Of Change Research Articles

Patterns of Workplace Supervisor Support Desired by Abused Women

The purpose of this study was to understand differences in patterns of supervisor support desired by female victims of intimate partner violence (IPV) and to examine whether the pattern of support desired at work is reflective of a woman's stage of change in the abusive relationship, IPV-related work interference, and IPV-related job reprimands or job loss. We conducted interviews in Spanish or English with adult women working in low-income jobs who had been physically or sexually abused by an intimate partner/ ex-partner in the past year ( N = 133). Cluster analysis revealed three distinct clusters that form a hierarchy of type of support wanted: those who desired limited support; those who desired confidential, time-off, and emotional support; and those who desired support in wide variety of ways from their supervisor. The clusters appeared to reflect stages of behavior change in an abusive relationship. Specifically, the limited-support cluster may represent an early precontemplation stage, with women reporting the least interference with work. The support-in-every-way cluster may represent later stages of change, in which women are breaking away from the abusive partner and report the greatest interference with work. Women in the confidential-, time-off-, and emotional-support cluster are in a transition stage in which they are considering change and are exploring options in their abusive relationship. Understanding the hierarchy of the type of support desired, and its relationship to stages of change in the abusive relationship and work interference, may provide a strong foundation for developing appropriate and effective workplace interventions to guide supervisors in providing support to women experiencing IPV.

Impact of a Stage-Tailored, Web-Based Intervention on Folic Acid–Containing Multivitamin Use by College Women

To examine effectiveness of a Web-based, stage-tailored folic acid intervention compared to non-stage-tailored education to promote folic acid-containing multivitamin use among college women. Pretest/posttest with random assignment to groups. Internet-based on college campus. Female college students (n = 408; mean age +/- SD = 20.8 +/- 2.6; range 18-29 years). Transtheoretical Model-based folic acid modules delivered over 4 weeks. Traditional brochure formatted online for nontailored group. Questionnaire assessing stage of change, self-efficacy, and decisional balance. Chi-square test and logistic regression. Results Of the participants who reported not taking a multivitamin at pretest, a greater proportion of participants in the tailored group (32.6%; n = 47) reported taking a multivitamin at posttest than in the nontailored group (19.9%; n = 27), chi(2)(1, n = 280) = 5.9, p = .015. At posttest tailored intervention participants were 2.5 times more likely to be in a later stage of change (odds ratio [OR] = 2.45; 95% confidence interval [CI] = 1.52, 3.99; p = .0003) and 2.3 times more likely to be in action (OR = 2.27; 95% CI = 1.28, 4.01; p = .005) than nontailored participants. They also had greater increases in self-efficacy and pros. Movement from precontemplation to a later stage occurred significantly more often in the tailored than in the nontailored group. Conclusion Stage-tailored vs. traditional folic acid education was more effective in improving stage of readiness to consume a folic acid-containing multivitamin. The Internet was a successful medium for targeting college females for preconception health care education.

A Quantitative and Qualitative Approach to Understanding Fruit and Vegetable Availability in Low-Income African-American Families with Children Enrolled in an Urban Head Start Program

Background Prior studies have shown low-income African Americans have low intakes of fruits and vegetables, which correlate, in part, to area of residence. To address the dietary problem, behavior-change interventions are most effective when they are theoretically based and compatible with cultural/behavioral characteristics of a given population. Objective To use the Transtheoretical Model of Behavior Change to determine whether low-income African Americans were in proportionately different stages of change for increasing fruits and vegetables to their young children and identify differences in decision making, self-efficacy, and use of cognitive and behavioral strategies related to fruit and vegetable availability. Design The two-phase, descriptive study utilized a mixed methodology consisting of a fruit and vegetable survey and focus groups. Subjects/setting Convenience sample of low-income African-American parents with children enrolled in an urban area Head Start program. Statistical analyses performed χ 2 test was calculated to examine the distribution of parents into stages of change for increasing fruit and vegetable availability. Analysis of variance was used to test differences in fruit and vegetable availability to children and parents' decision making, self-efficacy, and use of cognitive and behavioral strategies. Content analysis of focus group transcripts was used to triangulate quantitative findings and further explore meanings of survey responses. Results Of 94 participants completing the fruit and vegetable survey, 21% staged as precontemplation/contemplation, 25% staged as preparation, and 54% staged as action/maintenance ( P<0.001). Parents in action/maintenance stages served significantly more fruits and vegetables ( P=0.006) and used behavioral processes significantly more often ( P<0.001) compared to parents in precontemplation/contemplation stages. Content analysis of focus group transcripts provided greater insight into the quantitative findings. Conclusions Nutrition education targeting low-income African-American parents in earlier stages of change should address planning and preparing convenient and economical meals and snacks that include fruits and vegetables. Interventions targeting parents in later stages of change should address increasing variety and healthful preparation methods. Interventions for both groups can benefit from social support strategies.

Readiness to Change in Adolescents Screening Positive for Substance Use in Urban Primary Care Clinics

Primary care physicians often perceive patients as unlikely to decrease their substance use and suggest this reluctance to change diminishes their willingness to screen and intervene. The literature on readiness to change has primarily focused on adults, and the available studies on adolescents have largely included hospitalized and/or incarcerated youths with severe substance-related difficulties. The present study focuses on an urban primary care system's teenage population, which consists of youths typically engaging in less serious forms of substance use. One hundred sixty-eight of these youths ages 11 to 20 screened positive for substance use on a self-report questionnaire. These youths then completed the Readiness to Change Questionnaire. Nearly 60% of these positive screens were in the Action stage, with another 16% in the Contemplation stage. Depressive symptoms and suicidal ideation were positively associated with later stages of change. Implications for screening, prevention, and early intervention programs for adolescent substance use are discussed.

Stages of Change in Batterers and Their Response to Treatment

One important dimension of individual differences among batterers is their readiness to change. According to the transtheoretical model (Prochaska & DiClemente, 1984), all individuals go through precontemplation, contemplation, preparation, action, and maintenance before a change in behavior is accomplished. The applicability of this model to intimate partner violence was assessed by administering the University of Rhode Island Change Assessment (URICA) scales (with reference to their domestic violent behavior) to 210 court-ordered male batterers. Their responses were clustered, and two clusters were derived and then compared on other measures. As hypothesized, cluster 2 individuals (characterized by a profile of URICA scale scores suggesting an earlier stage of change) self-reported less initial distress (depression, anxiety, and alcohol abuse), less violence, and fewer problems with anger than cluster 1 individuals (characterized by URICA scale sores suggesting a later stage of change), although partners reported no difference in violence perpetrated by the two clusters. Cluster 1 individuals evidenced greater improvement in self-reported depression, anxiety, and anger control. Strategies to engage the more resistant cluster 2 individuals as well as suggestions for future research are considered.

Directed Thinking and Readiness to Change Self‐Beneficial Behaviors: Are You Ready for Some Studying?

Previous research has suggested that intentions to engage in studying and other self‐beneficial activities might be promoted more by thinking about actions one could take than by thinking about reasons for doing so. The present experiments assessed whether the relative efficacy of actions vs. reasons might depend on individuals' readiness to change. Consistent with previous findings on the processes of change most relevant in different stages, the benefits of self‐generated actions were more pronounced for participants who were in the later stages of change. This “matching‐to‐stage” relationship occurred in 2 experiments that differed in stage measurement, how thinking was directed, and which outcomes were measured. The results have both practical and theoretical implications for attempts to change self‐beneficial behaviors.

Appetitive nature of drug cues re-confirmed with physiological measures and the potential role of stage of change

Smokers report pleasant reactions to viewing cigarettes, suggesting that smoking cues may be appetitive in nature. Two studies have investigated this hypothesis through physiological assessment. The first study found that smoking cues were physiologically appetitive in nature, with dampened startle response to smoking pictures in comparison to neutral pictures. The second found that smoking pictures did not modulate the startle response, suggesting such cues may not be physiologically appetitive. The goal of the present study was to further investigate how participants' motivation to quit smoking might modulate responses to smoking cues. Twenty-two nicotine-dependent smokers viewed standardized pleasant, unpleasant, neutral, and smoking pictures. Eleven of the subjects reported no intent to quit (precontemplators) and 11 reported planning to quit within the next 6 months (contemplators). Acoustic startle probes were randomly administered while subjects viewed the pictures, and eyeblink startle magnitude was measured with electromyography (EMG). As a whole, participants exhibited dampened startle responses during smoking pictures, relative to unpleasant pictures. Precontemplators showed robust startle inhibition to smoking pictures, in comparison to both neutral and unpleasant pictures. Contemplators, however, showed blunted unpleasant picture augmentation and a lack of startle inhibition for pleasant pictures. These findings are consistent with the idea that smoking pictures are appetitive in nature. Furthermore, they suggest that smokers at a later stage of change may exhibit a lesser response.

Self-determination, stage of readiness to change for exercise, and frequency of physical activity in young people

Grounded in self-determination theory (Deci & Ryan, 1985) and the transtheoretical model (Prochaska & DiClemente, 1983), the aim of this study was to examine the relationship between exercise regulations varying in self-determination with stage of readiness to change for exercise and physical activity patterns in university students. A cross-sectional survey design was used. The sample consisted of 409 (158 men, 251 women) university undergraduates aged 18–30 years. Participants completed the Behavioural Regulations in Exercise Questionnaire-2, the visual analogue stage of change for exercise ladder, and a physical activity questionnaire. Linear discriminant function analyses revealed that men and women at the early stages were less self-determined in the regulation of their exercise behaviour than those at the later stages of change. Additionally, men and women who were more self-determined reported being more physically active over the previous 3 months. These results suggest that self-determination may have an important role to play in the adoption and maintenance of health-promoting behaviours in young adults.

The impact of stage-of-change on willingness to affiliate with smokers

This study assessed whether a smoker's stage-of-change (e.g., precontemplation, contemplation, preparation, action, or maintenance stage) impacted university students' intention to engage with that smoker in various social situations. Participants ( N = 187) were recruited by email and responded online to stimulus materials and dependent measures. Specifically, they read a vignette describing a smoker in one of the five stages of change (or a nonsmoker), and then completed a social affiliation measure (assessing intention to engage in relevant social situations with the vignette person), a modified version of the Attitudes Towards Smoking-18, and a demographic questionnaire. Participants were significantly more willing to affiliate with persons in the later stages of change compared to those in the early stages of change, and their willingness to affiliate was not correlated with expectancies of the effects of smoking.

INTENTION TO CHANGE DRINKING BEHAVIOUR IN GENERAL PRACTICE PATIENTS WITH PROBLEMATIC DRINKING AND COMORBID DEPRESSION OR ANXIETY

This paper examines the interaction of intention to change drinking behaviour with comorbid depression and anxiety in pro-actively recruited individuals with a range of drinking problems. Cross-sectional data of 408 general practice (GP) patients aged 18-64 years, who meet the diagnostic criteria of alcohol dependence or abuse according to DSM-IV, criteria of at-risk drinking or binge drinking, were drawn from a brief intervention study. Of the sample, 89 participants were diagnosed with comorbid anxiety and/or depressive disorders. The Transtheoretical Model (TTM) of behaviour change constructs: stages and processes of change, self-efficacy, and decisional balance were assessed in relation to presence and absence of the respective psychiatric disorders. Analysis including all categories of problematic drinking revealed comorbid anxiety and/or depression to be significantly related to later stages of change. Within subgroups, this was only true for alcohol abuse, not for dependence, at-risk or binge drinking. In addition, comorbidity was related to higher use of processes of change and more pros and cons of drinking, when compared to non-comorbid participants. Comorbid individuals showed higher temptation to drink and lower self-efficacy to abstain from drinking. Separate analyses of readiness to change drinking between the categories anxiety/no comorbidity and depression/no comorbidity both obtained significance, while for anxiety disorders, this was more profound. A multinomial logistic regression analysis revealed that adverse consequences better predicted readiness to change when compared to comorbidity. Individuals with problematic drinking and comorbid anxiety or depression may be well accessible for pro-active intervention to reduce drinking. Strategies should focus on the enhancement of coping skills to control temptation and self-efficacy.

The transtheoretical model and exercise adherence: examining construct associations in later stages of change

Abstract Objective Over 40% of Americans are sedentary and of those beginning an exercise program, 50% will drop out within 6 months. The Transtheoretical Model (TTM) is commonly used to describe exercise behavior and develop interventions for the initiation of exercise behavior. Less is known, however, about maintenance of exercise behavior and the construct associations for the action, maintenance, and termination stages of change. Thus, the purpose of this study was to examine which of the TTM constructs (i.e. decisional balance, processes of change, barriers-efficacy, and temptation) best distinguishes between the action, maintenance, and termination stages of change for men and women. Methods Questionnaires measuring each of the TTM constructs were collected from 330 men ( M age=27.14 years) and 380 women ( M age=24.80 years). Data were examined for sex differences and subsequently, two forward logistic regressions were conducted for each sex such that the dependent variables for the regressions were action/maintenance and maintenance/termination. Results Compared to men, women reported significantly less barriers-efficacy ( p =.04), greater pros of exercise ( p =.004), and greater use of behavioral ( p =.001) and experiential ( p p =.02), while barriers efficacy ( p =.001), environmental evaluation ( p =.02), and affect temptation ( p =.03) were associated with maintenance/termination. For the women, environmental reevaluation ( p =.02) and social liberation ( p =.05) were associated with action/maintenance, while barriers-efficacy ( p =.003) was the only construct correlated with maintenance/termination. Conclusions Stage and gender specific considerations are warranted when designing stage-matched exercise interventions for long-term maintenance of exercise behavior.

Psychosocial Characteristics Associated with Sun Protection Practices Among Parents of Young Children

Despite the importance of sun protection during childhood, many parents fail to adequately protect their children from the sun. The current study assessed sun-related knowledge, stage of change, and psychosocial characteristics of parents of young children. We examined how knowledge and psychosocial characteristics differed by stage of change, and tested a model of the relationship among demographics, knowledge, psychosocial variables, and child sun protection. Surveys were completed by 391 parents of preschool-aged children. Parent knowledge about skin cancer was relatively high and did not vary by stage of change. Parents in earlier stages of change perceived more barriers to child sun protection, had more positive beliefs about children's sun exposure, perceived their child to be less susceptible to sun damage, and had lower self-efficacy for child sun protection than did parents in later stages of change. In a path model, the strongest predictors of child sun protection were parents' own sun protection habits, perceived barriers, and self-efficacy. Results highlight the importance of parent psychosocial characteristics in predicting child sun protection.

Exercise causality orientations, behavioural regulation for exercise and stage of change for exercise: exploring their relationships

Abstract Objectives The objectives are to (a) explore the relationship between exercise causality orientations and stages of change and in doing so highlight any motivational changes that accompany movement through the stages, and (b) investigate the relative importance of exercise causality orientations and behavioural regulations in discriminating stage of change. Methods One hundred and one female ( M age =28.85±11.21) and 83 male ( M age =33.99±13.86) volunteers completed the Stage of Change for Exercise Ladder, the Exercise Causality Orientations Scale (ECOS) and the Behavioural Regulation in Exercise Questionnaire (BREQ). Results For both males and females, levels of the autonomy orientation increased across the stages of change while levels of the control orientation remained stable. Taking the ECOS and BREQ in combination, only identified and introjected regulation distinguished stage of change. Less self-determined regulations decreased as exercise participation increased but intrinsic regulation was not increased by longer participation in exercise. Conclusions The autonomy orientation and more self-determined extrinsic motivation were related to later stages of change for exercise but the nature of this study precludes the ability to make causal inferences. The BREQ subscales seem to be more important for discriminating stage of change than the ECOS subscales, however, the causal relationship between the development of causality orientations and behavioural regulations is not yet known.

Stage of Change as a Predictor of Attrition Among Men in a Batterer Treatment Program

This study assessed the contribution of the men's stage of change to the prediction of attrition among men attending a batterer treatment program. As outlined by the transtheoretical model of change, men were classified into the precontemplation, contemplation, or action stage based on their level of change motivation and behavior. It was hypothesized that men in the precontemplation stage would dropout of treatment at higher rates than men in later stages of change. Participants were 308 men who enrolled in a batterer treatment program over the course of 1 year, 61.4% of whom dropped out of treatment. Counselor rated, but not self-rated stage of change significantly predicted treatment completion once traditionally used demographic, contextual, and personality variables were taken into account. Specifically, men identified by counselors as being in the precontemplation stage were 2.3 times as likely as men rated in the contemplation stage and 8.8 times as likely as men rated in the action stage to dropout of treatment. Referral source, age, and history of arrest also made significant contributions to the prediction of attrition. The best combination of predictors led to the successful classification of 72% of the cases, 98% of the dropouts but only 19% of the completers. Discussion focuses on the limitations of current findings and their implications for the use of the transtheoretical model to predict attrition from batterer treatment.

THE TRANSTHEORETICAL MODEL OF BEHAVIOR CHANGE: ITS POTENTIAL USE WITH YOUTH

2011 PURPOSE: The potential application of the Transtheoretical Model of Behavior Change (TMBC) to youth exercise behavior was explored. METHODS: Subjects (n = 191) completed a questionnaire designed to evaluate their self reported physical activity levels, stages of change, processes of change and self-efficacy for exercise. Subjects' body composition and fitness levels were also measured. RESULTS: Distribution of the sample across the stages was: precontemplation, n = 15; contemplation, n = 20; preparation, n = 35; action, n = 30; and maintenance, n = 91. Analysis of the biological/behavioral measures (fitness level, body composition, reported physical activity level) indicated that there were significant differences (p < 0.05) between stages of change for all measures. Post hoc analysis indicated that those in the later stages of change were more fit, had lower body composition and were more active than those in earlier stages. Analysis of the psychological measures (ten processes of change and self-efficacy for exercise) indicated that there were significant differences (p < 0.05) between stages of change for self-efficacy and several processes of change. Post hoc analysis indicated that later stages of change scored significantly higher on the self-efficacy scale and used processes of change more often than earlier stages of change. Significant differences were found between genders for body composition and eight of the ten processes of change. DISCUSSION: Overall the results indicate that the TMBC has potential for use with younger populations.

Assessing decisional balance for smoking cessation among Southeast Asian males in the US.

This study examines the relationship of positive and negative perceptions of smoking to self-reported readiness to quit smoking among Southeast (SE) Asian males of Cambodian, Laotian or Vietnamese descent. In order to investigate this relationship, measures of decisional balance constructs (i.e. the pros and cons of smoking) appropriate for these ethnic groups were developed. Decisional balance was calculated by subtracting the cons from the pros. Following the criteria established by Prochaska and DiClemente, subjects were categorized into four levels of readiness to quit smoking (precontemplation, contemplation, preparation/action and maintenance). The expected pattern of relationship between decisional balance and stages of change included: (1) the cons of smoking being of less importance than the pros of smoking for those smokers in the precontemplation stage, (2) the pros and cons intersecting at the contemplation stage, and (3) the cons being of greater importance than the pros in the later stages of change. The SE Asian men in this study did not exhibit these decisional balance patterns, although mean decisional balance scores for precontemplators and contemplators were significantly more positive than mean scores for those in the preparation/action and maintenance stages. Decisional balance patterns differed across the three ethnic groups included in the sample.

Stages of Change of Smoking Cessation: Relationships With Other Health Behaviors

Health behaviors are often intercorrelated, suggesting that these behaviors may be manifestations of underlying attitudes toward health. Changes in these attitudes may cause simultaneous changes in several health behaviors. As individuals progress among the stages of change of one health behavior, such as smoking cessation, they may make changes in other health behaviors as well. This study evaluated the hypothesis that subjects in the later stages of change of smoking cessation would practice more healthful behaviors than subjects in the early stages of change. Subjects were 929 respondents in the California Behavioral Risk Factor Surveillance Study who were current smokers or had quit smoking within the past year. Subjects in the more advanced stages of smoking cessation showed more healthful levels of alcohol use and exercise than subjects in the earlier stages. These results suggest that people may make improvements in several health behaviors concurrently. If so, lifestyle-based health promotion programs may be able to take advantage of shifts in attitudes toward health behavior to modify several health behaviors simultaneously.

The smoke-free university: anticipating health education needs of faculty and staff.

A survey instrument was developed to assess the anticipated impact of smoke-free university policy on faculty and staff and to recommend health education interventions based on stages of change theory and employee interest. Four months before the policy was implemented, the 25-item anonymous questionnaire was sent to a random sample of 1,000 faculty/staff. A majority of university workers (85.5%) are not smokers and approve of the no-smoking policy. Smokers (14.5%) are older than nonsmokers, are more likely to have a high school versus higher education, and are more likely to be maintenance or clerical workers. Most smokers smoke less than one pack per day and smoke outdoors during work hours. More smokers were in later stages of change (planning to stop soon) than expected. Interest in availability of smoking cessation activities differed by smoking status and change stage.

Milk Spoilage Poster

In many secondary schools today there is a great need to focus, or hook, students' attention on a particular subject. One way to do this in a middle school is to use a poster that is both informative and humorous. An interesting poster that is followed by questions can get students' attention and interest effectively. The poster followed by questions and answers with students makes the lesson student-centered rather than teachercentered. We have made a poster on milk spoilage for a middle school life science class. This idea can be adapted for elementary school or high school introductory biology classes. Our poster illustrates milk spoilage in cartoon form. Mr. Lactose smiles at milk kept in the refrigerator (pH = 7.0), and he cries when milk is kept at room temperature (pH = 4.0). Also, when milk is at room temperature, Mr. Lactose has a vision where Streptococcus, Lactobacillus, Escherichia coli, Bacillus bacteria and yeasts spoil milk. Milk is an ideal medium for bacteria. Bacteria have an important role in milk's freshness and spoilage. Most bacteria in milk are killed through pasteurization, however, some remain. Milk kept in a refrigerator will be reasonably fresh for seven to ten days. Milk spoils after one to two days if kept at room temperature. Milk spoilage is a result of the metabolism of lactose (milk sugar) into lactic acid that causes the acidity of milk to increase. The pH of fresh milk is about 7 and of spoiled milk about 4; this increases somewhat in the later stages of change. A demonstration of milk chemistry will enhance the poster idea. Demonstration: Before Class Preparations