Precontemplation Stage Research Articles

Constraints to Chinese women’s leisure-time physical activity across different stages of participation

ABSTRACTThe goal of this study was to further the understanding of leisure-time physical activity (LTPA) constraints across different stages of LTPA as described by the Transtheoretical Model (TTM). Data were collected from female adults (n = 1257) who resided in a metropolitan area in Eastern China using self-administered questionnaires. To examine the potential differences among three types of constraints (e.g. intrapersonal, interpersonal, and structural) within and across each of the five stages of LTPA, a series of ANOVA tests with Scheffe’s post hoc analyses were conducted.The influence of intrapersonal constraints peaked at the precontemplation and contemplation stages, while the influence of interpersonal and structural constraints declined in the maintenance stage. In the precontemplation stage, the intrapersonal constraints were more salient than interpersonal constraints. In the later three stages (e.g. preparation, action, and maintenance), structural constraints were the most salient physical activity barriers.These new findings suggest that the effects of LTPA constraints on TTM stages may be context (e.g. metropolitan China) and population (e.g. females) specific. The study findings can inform future stage-based LTPA constraint research among targeted audiences in different cultures/countries and may inform interventions to promote physical activity levels for Asian women at different stages of participation.

The impact of motivational interviewing on behavior stages of nulliparous pregnant women preparing for childbirth: a randomized clinical trial

Objective: To examine the effectiveness of motivational interviewing (MI) on the stages of behavior change among nulliparous pregnant women who were preparing for childbirth.Methods: In this randomized clinical trial, 234 pregnant women were studied in two intervention groups (MI and lecture), and one control group at three stages. In weeks 16–19 of pregnancy, two counseling sessions were held for the MI group, and one lecturing session was held for the lecture group. In weeks 21 and 37 of pregnancy, the three groups were reevaluated.Results: At baseline, more than 70% of women were at pre-contemplation and contemplation stages. In week 21 of pregnancy, in MI 71% were at preparation stage, whereas in the lecture and control groups, 51.9% and 49.4% were at the contemplation stage, respectively. In week 37 of pregnancy, in MI, lecture and control groups, 90%, 59.7% and 27.3% were at the action stage, respectively (p < .001). The result of generalized estimating equation (GEE) analysis using a Poisson model indicated that the incident rate for lecture group was 1.7 (95% CI: 1.2–2.5) times the incident rate for the MI group. Also, the incident rate for control group was 3.4 (95% CI: 2.2–5.0) times the incident rate for the MI group.Conclusions: Motivational interviewing was effective in guiding nulliparous mothers toward positive behavior stages.

Stages of Change for Mammography Among Mexican Women and a Decisional Balance Comparison Across Countries.

An analysis of the adoption of secondary preventive behaviors is significant in regions with disparities in mammography use and breast cancer survival. Therefore, we determined the cognitive factors and the degree to which they differentiate stages of change in mammography among Mexican women. We also compared the decisional balance performance at Mexico, Switzerland, South Korea, and the USA. A cross-sectional study was designed for women in the stages of precontemplation (n=240), contemplation (n=243), action (n=205), maintenance (n=311), and relapse (n=348). We only considered those ≥40years with no cancer history. We measured the pros, cons, and self-efficacy, among other components. The decisional balance was estimated, and the result was transformed into T-scores. Odds ratios (OR) and 95% confidence intervals (CI) were estimated with multinomial logistic regression using precontemplation as the reference group. The decisional balance distinguished stages partially: in contemplation, the OR was 1.26 (95%CI 1.08, 1.47) and in maintenance, 1.34 (95%CI 1.13, 1.59); in action and relapse, the statistical significance was marginal (p<0.10). The decisional balance T-score performance registered variations among countries. Additionally, the effect of self-efficacy progressively ascended from contemplation to action and maintenance (OR=1.29 [95%CI 1.05, 1.58], 1.53 [95%CI 1.20, 1.96], and 2.48 [95%CI 1.82, 3.39], respectively). Furthermore, risk perception and severity did not have an effect on stages of change among Mexican women. Recognition of what provokes action in a population is a key factor in the efficacy of screening programs. Variations among countries highlight the necessity for importance of investigating cognitive determinants for mammography in specific areas.

Determinants of mammography adoption among iranian women: What are the differences in the cognitive factors by the stages of test adoption?

ABSTRACTOur aim in this cross-sectional study was to investigate the predictors of the stages of change in mammography adoption (MA) based on Health Belief Model among Iranian women. Through multistage cluster sampling, we recruited and interviewed 1131 women older than 40. After statistical adjustment for other risk factors, perceived barriers (OR D 0.84, 95% CI D .81–.87) and benefits (OR D 1.17, 95% CI D 1.11–1.24) were significant predictors for MA. Majority of the women were in the pre-contemplation and contemplation stages of change for MA. Our findings are informative for the development of targeted interventions to foster MA among women.

Contrasting Trends of Smoking Cessation Status: Insights From the Stages of Change Theory Using Repeat Data From the Global Adult Tobacco Survey, Thailand (2009 and 2011) and Turkey (2008 and 2012)

ObjectiveThe World Health Organization recommends that smokers be offered help to quit. A better understanding of smokers’ interest in and commitment to quitting could guide tobacco control efforts. We assessed temporal differences in stages of change toward quitting among smokers in Thailand and Turkey.MethodsTwo waves (independent samples) of data from the Global Adult Tobacco Survey, a national household survey of adults aged 15 years or older, were assessed for Thailand (2009 and 2011) and Turkey (2008 and 2012). Current smokers were categorized into 3 stages of change based on their cessation status: precontemplation, contemplation, and preparation. Relative change in the proportion of smokers in each stage between waves 1 and 2 was computed for each country.ResultsBetween waves, overall current tobacco smoking did not change in Thailand (23.7% to 24.0%) but declined in Turkey (31.2% to 27.1%; P < .001). Between 2009 and 2011, precontemplation increased among smokers in Thailand (76.1% to 85.4%; P < .001), whereas contemplation (17.6% to 12.0%; P < .001) and preparation (6.3% to 2.6%; P < .001) declined. Between 2008 and 2012, there were declines in precontemplation among smokers in Turkey (72.2% to 64.6%; P < .001), whereas there were increases in contemplation (21.2% to 26.9%; P = .008) and no significant change in preparation (6.5% to 8.5%; P = .097).ConclusionNearly two-thirds of smokers in Turkey and more than two-thirds in Thailand were in the precontemplation stage during the last survey wave assessed. The proportion of smokers in the preparation stage increased in Turkey but declined in Thailand. Identifying stages of cessation helps guide population-based targeted interventions to support smokers at varying stages of change toward quitting.

Behaviour Change Towards Cycling in 7 Case Study Cities

Background In order to increase the levels of physical activity in urban population, it is essential to know how a behavioural change towards cycling as active mobility can be produced and what factors influence people in their choice to cycle. But few studies have done longitudinal analysis of behavioural changes in cycling in relation to their policy context. Methods As part of the PASTA European project (Physical Activity through Sustainable Travel Approaches), a longitudinal survey in 7 European cities will provide the core data for the analysis. This survey was closed the 13th January 2017, after 2 years of data collection. The PASTA survey features specific questions designed to determine the attitudinal and behavioural profile of the participants. The conceptual framework used for the behavioural change assessment features an adaptation of the Transtheoretical Model of Behaviour Change and further developments, which describes five stages of change: Precontemplation, Contemplation, Preparation, Action and Maintenance. The sub-set of questions to determine the stage of change diagnosis are included in the initial (baseline) and final questionnaires, so that a “before” and “after” analysis can be undertaken. Other relevant psycho-social variables featured in the questionnaires will also be explored. The survey data is being complemented with background information including cycling policy and GIS data. Results Our sample is 10,557 participants across the seven cities (subject to further data cleaning). For this sample, a cross-city analysis of behavioural questions will be explored and compared for the initial (baseline) and final questionnaires. The baseline questionnaire has been already analysed and is showing a share of 23% of the sub-sampled participants (n=7,580) in the Precontemplation stage, 7% in Contemplation, 18% in Preparation, 41% in Action and 11% in Maintenance. In this presentation, results will be shown from the complete dataset (that is including all questionnaires) detailed for each of the seven cities, which is being analysed at the moment. The results of the stage diagnosis will be crossed with several socio-demographic variables, such as income, age, education level and sex. As an example, mean age is 40.08 (13.04) years and 54% of the participants are female. Conclusions Understanding the relative importance of the factors influencing mobility behaviour will help to determine the most promising policy avenues for the change towards cycling. This study puts together a unique mix of theories and methods in order to explore the bridges between behavioural change science and policy making.

Fruit and Vegetable Consumption in High School Students in Bandar Abbas, Iran: An Application of the Trans-theoretical Model.

A diet rich in fruits and vegetables is of a great importance, especially to adolescents due to their need for nutrients and their rapid growth. The aim of this study was to investigate the relationship between decisional balance and self-efficacy with stages of change for fruit and vegetable consumption in high school students in Bandar Abbas, Iran. In this descriptive-analytical study, data were collected from 345 students studying in eight high schools of Bandar Abbas who were selected through multistage sampling. To collect data, separate questionnaires were designed for evaluating each of the variables, including the stages of change, perceived benefits, perceived barriers, and self-efficacy of fruit and vegetable consumption. Decisional balance was estimated by subtracting the perceived benefits and barriers. The data were analyzed with one-way ANOVA using SPSS 19. The results of this study indicated that the individuals' progress along the stages of change from pre-contemplation to maintenance level was associated with a significant increase in their decisional balance and self-efficacy for fruit and vegetable consumption (P < 0.001). The lowest level of decisional balance and self-efficacy regarding fruit showed up in the pre-contemplation stage, and the highest level of decisional balance and self-efficacy was in the maintenance stage. Similar trends were observed for vegetable consumption. Decisional balance and self-efficacy should be considered in designing interventions to increase consumption of fruits and vegetables. There needs to be more emphasis on educational programs based on the Trans-theoretical Model (TTM) for the enhancement of perceived benefits and elimination of perceived barriers regarding consumption of fruits and vegetables.

Relationship Between Regular Physical Activity and Transtheoretical Model Components Among Members of Municipality Councils in Selected Districts of Tehran

Background: The Trans theoretical model (TTM) is developed as a framework for understanding the process of behavior changes. It is known as the most popular approach for promoting exercise behavior. The main objective of this study is to determine the relationship between regular physical activity and TTM components among members of municipality councils in selected districts of Tehran. Methods: This quasi-experimental research with non-equivalent control groups was conducted as a cross-sectional study with 207 members of municipality councils at districts 17 and 20 of Tehran. Data gathering instruments included: demographic; physical activity stage of change; processes of change (researcher-made); self-efficacy, and decisional balance questionnaires. Reliability, and construct validity were evaluated through appropriate statistical procedures. To analyze the data, applied statistical tests such as: chi-square, regression, Pearson correlation coefficient and ANOVA were performed using SPSS 22 software. Results: The level of physical activity of municipality council’s members were: 43.5, 12.1, and 44.4 at low, moderate, and appropriate activity levels, respectively. The results showed that 18.9, 15.9, 10.1, 24.7and 30.4 percent of municipality council’s members were in the pre contemplation, contemplation, preparation, operation and maintenance stages consequently. The stages of change could predict physical activity in the municipality councils (P < 0.05). However, all the components of this model were significantly associated with regular physical activity behavior. There was a significant relationship between the structures of the processes of change, benefits and barriers against regular physical activity. Conclusions: Although, 43.5 of municipality council’s members did not have any intention of performing physical activities in the next six months, it is important to them to recognize the need for physical activity as the main behavior to increase physical and mental health and to be in the maintenance stage of their physical activity behavior. According to the most important predicting components in this study, educational intervention must be focused on in order to increase the effectiveness of the programs to promote municipality councils’ physical activity. © 2017, Asian Journal of Sports Medicine.

A Study on the Effectiveness of the Integrated Case Management Program focused on Rapport in the Jjok-Bang (Small Single Room) Homeless having Alcohol Use Disorder at Precontemplation Stages

A Study on the Effectiveness of the Integrated Case Management Program focused on Rapport in the Jjok-Bang (Small Single Room) Homeless having Alcohol Use Disorder at Precontemplation Stages

Brief intervention to promote smoking cessation and improve glycemic control in smokers with type 2 diabetes: a randomized controlled trial

The aim of the study was to examine the effects of a brief stage-matched smoking cessation intervention group compared with a control group (with usual care) in type 2 diabetes mellitus patients who smoked by randomized controlled trial. There were 557 patients, randomized either into the intervention group (n = 283) who received brief (20- minute) individualized face-to-face counseling by trained nurses and a diabetes mellitus-specific leaflet, or a control group (n = 274) who received standard care. Patient follow-ups were at 1 week, 1 month, 3 months, 6 months, and 12 months via telephone, and assessment of smoking status from 2012 to 2014. Patients smoked an average of 14 cigarettes per day for more than 37 years, and more than 70% were in the precontemplation stage of quitting. The primary outcome showed that both the intervention and control groups had similar 7-day point-prevalence smoking abstinence (9.2% vs. 13.9%; p = 0.08). The secondary outcome showed that HbA1c levels with 7.95% [63 mmol/mol] vs. 8.05% [64 mmol/mol], p = 0.49 at 12 months, respectively. There was no evidence for effectiveness in promoting the brief stage-matched smoking cessation or improving glycemic control in smokers with type 2 diabetes mellitus, particularly those in the pre-contemplation stage.

Prevalence and factors associated with stages of behavior change for physical activity in adolescents: a systematic review.

To analyze prevalence and factors associated with stages of behavior change for physical activity in adolescents. A search was performed in SciELO, PubMed, PsycINFO, SPORTDiscus and LILACS. The search terms were "behavior change" OR "stages of change" OR "stages of readiness" OR "readiness to change" OR "transtheoretical model" OR "process to change" OR "decisional balance", and "motor activity" OR "physical activity" OR "physical exercise" and "adolescent" OR "students". After the eligibility criteria, 18 articles were selected. The highest prevalence of adolescents in the precontemplation, contemplation, and preparation stages was found in the Germany, South Korea, and Iran while there were more adolescents in the action and maintenance in South Korea and Brazil. The evidence of association indicated that females are more likely to be in precontemplation, contemplation and preparation. The evidence was inconclusive for age (in relation to the precontemplation, contemplation, action and maintenance stages), economic status (all stages), shift of study (when stratified by gender) and body composition (all stages). No association was found with parental level of education. The findings can help to guide interventions and further research on the topic of behavior changes for physical activity in adolescents.

Association of Trans-theoretical Model (TTM) based Exercise Behavior Change with Body Image Evaluation among Female Iranian Students

BackgroundBody image is a determinant of individual attractiveness and physical activity among the young people. This study was aimed to assess the association of Trans-theoretical model based exercise behavior change with body image evaluation among the female Iranian students.Materials and MethodsThis cross-sectional study was conducted in Sanandaj city, Iran in 2016. Using multistage sampling method, a total of 816 high school female students were included in the study. They completed a three-section questionnaire, including demographic information, Trans-theoretical model constructs and body image evaluation. The obtained data were fed into SPSS version 21.0. ResultsThe results showed more than 60% of participants were in the pre-contemplation and contemplation stages of exercise behavior. The means of perceived self-efficacy, barriers and benefits were found to have a statistically significant difference during the stages of exercise behavior change (P<0.05). Moreover, there was a significant correlation between the stages of exercise behavior change and fitness evaluation, fitness orientation, subjective weight and body areas satisfaction subscales (P<0.05). The interaction effect of self-efficacy and body image on exercise behavior were reported to be statistically significant (P<0.05).ConclusionThe findings of this study indicated poor physical activity and effect of body image on doing exercise. Body image and designing interventions to promote exercise behavior are suggested to be taken into account.

Implementation of an exercise behavior change clinic for men with prostate cancer: Baseline results.

169 Background: Regular physical activity (PA) and resistance training (RT) has been shown to improve the health of prostate cancer survivors (PCS), however participation rates are low. To address survivorship needs and support behaviour change, the Prostate Cancer Supportive Care (PCSC) program implemented an Exercise Physiology (EP) clinic using one-on-one exercise counselling. Our objective was to understand the PA and RT characteristics of PCS and examine the effect of an EP clinic on behaviour change. Methods: After enrolment in the PCSC program, PCS were offered a consultation with an Exercise Physiologist. Subsequent consultations occurred at 3, 6 and 12 months. Clinical data collected at each consultation included physical measures, stage of change (TTM), current exercise (GLTEQ and exercise summary), fatigue (FACIT Fatigue and SIFIR), barriers and facilitators to exercise and a safety screening (PAR-Q+). Information was used during the EP clinic to set PA goals and create an action plan for behaviour change, reviewed each visit. Results: 71 PCS, median age 67 (range 50-86) attended the EP clinic between July 2015 and August 2016. 76% had received primary treatment and 24% were on active surveillance. At first consultation, 63% had an at-risk health profile, with an average BMI of 27kg/m2 (overweight), average waist circumference of 102.6cm (high) and insufficient PA, with only 15% meeting both PA and RT guidelines (150 mins moderate-to-vigorous PA and 2 RT sessions weekly). Average reported fatigue was moderate (4/10 on SIFIR). Stage of change (TTM) showed 44% of PCS at pre-contemplation, contemplation or preparation stages and 54% at action or maintenance stages. Self-reported barriers to exercise included lack of time (24%), laziness (19.7%) and fatigue (18%), while exercising with a spouse/friend/team was the main facilitator to exercise (16.9%). Conclusions: The baseline PA and RT levels of EP clinic PCS is similar to population norms in that the majority of PCS are not meeting current guidelines. Our results demonstrate that the implementation of an EP clinic is feasible. Future follow-up of this cohort will evaluate whether the program creates sustainable PA behaviour change in PCS.

Abstract C50: Applying the Stages of Change Model to breastfeeding in African-American women: A qualitative study

Abstract Background: Breastfeeding is the optimal form of infant nutrition, and has numerous health benefits for both infant and mother. One such maternal health benefit is decreased likelihood of breast cancer. Breastfeeding trends in the United States have improved in the past decade. However, racial disparities remain, with African-American women having the lowest breastfeeding rates among all racial/ethnic groups. Although breastfeeding trends in African-American women have also improved greatly, current rates do not meet Healthy People 2020 objectives. According to the CDC, African-American women are more likely to develop an aggressive form of breast cancer (triple negative) and also have a higher mortality rate from breast cancer. In addition, breast cancer has a tendency to onset at younger ages in African-American women. Thus, efforts to improve breastfeeding initiation and duration rates in this population can help alleviate breast cancer disparities. The Stages of Change model is one behavioral health theory useful in gauging readiness to adopt a preventive health behavior. There is a gap in the breastfeeding literature regarding the usefulness of this theory for breastfeeding in African-American women. The current research described here helps to fill that gap. Study Question: How can the Stages of Change model be used to increase motivation and readiness to initiate and sustain breastfeeding in African-American women? Methods: A secondary data analysis was conducted of qualitative data from a dissertation exploring the long-term breastfeeding experiences of African-American women. In the first study, 3 focus group discussions were conducted with 23 WIC breastfeeding peer counselors (PCs) to better understand breastfeeding norms and behavior of the African-American women they serve. Focus groups were conducted at community health clinics and lasted approximately 90 minutes. In the second study, semi-structured individual interviews were conducted with 11 African-American mothers who were WIC participants (identified as positive deviants), who had breastfed one child for at least 6 months, and the breastfed child was younger than 2 years old. Interviews were conducted in participant homes or public settings (ie. library, café) and lasted approximately 60 minutes. Both focus groups and interviews were audio-recorded and conversations were transcribed. Data was coded by two researchers and analyzed using thematic analysis techniques. The Stages of Change model was used as a guide in the secondary data analysis. Results: WIC PC's and interview participants described historical and socio-cultural complexities influencing African-American women's breastfeeding behaviors. Four themes developed across both studies about African-American women's motivation and readiness to breastfeed using the Stages of Change model and strategies useful to encourage breastfeeding at each stage of behavioral change. 1) Pre-contemplation Stage: Increasing Breastfeeding Awareness (preconception and pregnancy); 2) Contemplation &amp; Preparation Stages: Breastfeeding Decision-Making (pregnancy and childbirth); 3) Action Stage: Initial Breastfeeding Triumphs and Trials (childbirth and early postpartum period); 4) Maintenance Stage: Committing to Long-term Breastfeeding (extended postpartum period). Conclusions: Findings indicate opportunities to enhance breastfeeding education and strengthen breastfeeding support for African-American women at each stage of behavioral change. Lessons learned can be used in designing culturally-tailored breastfeeding interventions for African-American women and also a survey tool to assess women's readiness to breastfeed. Healthcare providers and researchers should be aware of the unique historical and socio-cultural complexities influencing African-American women's breastfeeding behaviors when developing interventions. By improving breastfeeding in African-American women, aggressive breast cancer in may be prevented. Citation Format: Tyra Gross. Applying the Stages of Change Model to breastfeeding in African-American women: A qualitative study. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C50.

The Effect of a TTM-Based Intervention on the Level of Physical Activity in ICU Nurses

Background: Theory-oriented interventions play a key role in promoting people’s quality of life and preventing the risks of immobility. Given this key role and also the critical nature of nurses’ professional duties, the present study was conducted to determine the effect of a TTM (trans theoretical model)-based intervention on the level of physical activity in ICU nurses working at hospitals affiliated to Gilan University of Medical Sciences. Methods: Based on the study objectives, this randomized controlled trial first selected 82 nurses through the census method in order to determine their Stage of Change (SOC) and then assigned 68 nurses who were in the first three stages into a case group and a negative control group. Valid and reliable data collection tools were used, including a demographic questionnaire and the TTM constructs (SOC, GPAQ, SE, DB and POC). The path analysis of the data was performed inLisrel-8.80 and the inter-correlation matrix between the models constructs them and with the level of physical activity was determined in order to design and implement the intervention. A two-stage assessment was performed, once immediately after the intervention and again six months later. The data obtained were analyzed using appropriate statistical tests and Pearson’s correlation coefficient. Results: A total of 97.6% of the participants were female, 59.8% were married, 92.7% had bachelor’s degrees and 82.9% were in the first three stages of the TTM. Immediately after the intervention, 55.9% of the participants were in the preparation stage, 44.1% were in the pre-contemplation stage and 76.5% were in the contemplation stage. Before the intervention, however, only 26.5% of the participants were in preparation and 44.1% were in precontemplation. There was a statistically significant difference (P=0.0001) between the negative control and the case groups immediately and six months after the intervention. Conclusion: Performing the TTM-based intervention appears to have led to the subjects’ placement in higher levels in the five SOC.

Parenting Skills Determinant in Preventing Adolescents’ Sexual Health Risk Behavior

Parenting skill is one of the crucial needs that parents must have in caring adolescents’ sexual health risk behavior. Present study aims to determine predictors of parenting skills in preventing adolescents’ sexual health risk behavior. A cross sectional study was conducted among adolescents’ parents who attended government health clinics in a semi-urban district, West Malaysia. Data were collected by systematic random sampling using validated questionnaire from eight government health clinics based on routine daily out-patient services. There were 386 respondents participated with 98.9% of response rate. Parental skill is categorized as appropriate or inappropriate based on Trans-Theoretical Model (TTM) staging. Eighteen independent variables were used: parental socioeconomic status, adolescent characteristic, parenting style, parent-adolescent communication, parental stress, perception on adolescent sexual risk, comfortable in discussing sexual issues, knowledge in sexual reproductive health (SRH) and knowledge in HIV/AIDS. Assessment of parenting skills using the TTM stage showed 139 respondents (36%) had inappropriate parenting skills, in which they were in pre contemplation, contemplation or preparedness stages, while 247 respondents (64%) showed appropriate parenting skills when they were in action and maintenance stages of TTM. Older parent, late adolescent, low parental education level, extended family living arrangement, comfortable in discussing sexual issues, good parent-adolescent communication and higher knowledge in HIV/AIDS were found significant in bivariate analysis. Multivariate logistic regression analysis identified older parent (AOR = 1.927, 95% CI = 1.889 - 1.966, p < 0.001), lower parental education (AOR = 2.394, 95% CI = 1.348 - 4.254, p = 0.003), comfortable in discussing sexual issues (AOR = 3.810, 95% CI = 1.622 - 8.948, p = 0.002), good parent-adolescent communication (AOR = 4.741, 95% CI = 2.478 - 9.071, p ≤ 0.001) and having higher knowledge on HIV/AIDS (AOR = 2.804, 95% CI = 1.528 - 5.147, p = 0.001) as significant predictors for appropriate parenting skills in preventing adolescent sexual health risk behavior. In conclusion, more than one third of parents were still not ready in preventing adolescent sexual risk behavior. Targeting the young parents and those having difficulty in communicating sexual issues with theirs adolescents should be emphasized in early intervention program for parents. Self-assessment using TTM stage questionnaire will help parents to identify their parenting skills in preventing adolescent sexual health risk behavior.

Motivation to change and factors influencing motivation in alcohol dependence syndrome in a tertiary care hospital.

Context:Motivation plays an important role in the treatment of alcohol dependence syndrome (ADS) by influencing the patient to seek and comply with treatment as well as make successful long term changes.Aim:The aim of this study is to study the motivation for change in inpatients with ADS.Settings and Design:One hundred consecutive patients admitted for the treatment of ADS in a medical college hospital were evaluated.Materials and Methods:The International Classification of Disease 10th Revision - AM symptom checklist for mental disorders screener and appropriate modules were used to establish ADS. The assessment of motivation was done using the University of Rhode Island Change Assessment scale at baseline and after 2 weeks of admission. The Severity of Alcohol Dependence Questionnaire and Kuppuswamy's scale for socioeconomic status were used.Statistical Analysis:Paired and unpaired t-test, Fisher's exact test, and Wilcoxon signed-rank test were used to analyze data.Results:The assessment of motivation showed 60% of patients in precontemplation (PC) stage at baseline, compared to 34% of the patients in PC, 57% in contemplation, and 9% in action stage after 2 weeks of inpatient stay. A highly significant change was seen in the levels of motivation toward contemplation and action stage after 2 weeks of inpatient stay (Z = 5.745, P < 0.001). Motivation to change had a significant association with complications of alcohol use, medical comorbidity, onset and severity of alcohol dependence, socioeconomic status, religion, and mode of referral.Conclusions:The study concludes that certain patients with ADS may have low pretreatment levels of motivation, with significant improvement in the motivation levels after a short duration of inpatient treatment.

Comparison of Public Health Nurse’s Lifestyle Counseling Skills for Clients with Different Readiness of Behavior Changes in Primary Care Settings

Purpose: Public health nurses (PHNs) are required to assess the readiness of the clients and provide lifestyle counseling accordingly. The purpose of this study was to compare the lifestyle counseling provided for clients with different levels of readiness based on self-evaluations and independent assessment. Methods: Participants were PHNs with 10 years’ experience or less. Lifestyle counseling skills were measured through a simulated counseling session in a primary setting lasting up to 30 minutes, followed by a review session, where the participant provided self-evaluations, and the simulated client provided others-evaluations, of the session. The simulated clients played the role of clients at either the pre-contemplation or contemplation stage of preparedness as per the stages of behavior change theory. Results: The self-evaluation results showed that the mean scores for five of the six skill categories, are lower in the precontemplation-stage client cases than in the contemplation-stage client cases, and significantly so for two skill categories. The others-evaluations showed significantly lower mean scores for all skill categories in the precontemplation cases than in the contemplation cases. Conclusion: The PHNs and simulated clients agreed that lifestyle counseling skills were inadequate for the precontemplation cases, as compared with the contemplation cases. The lifestyle counseling skills of PHNs with less experience may not be well-adjusted to the readiness of the client, indicating difficulties in supporting less prepared clients.

Does knowledge of physical activity recommendations increase physical activity among Chinese college students? Empirical investigations based on the transtheoretical model

BackgroundBased on the transtheoretical model, the current study investigated whether awareness of physical activity (PA) recommendations had an impact on the stages of PA behavior change and levels of PA among Chinese college students. MethodsIn Study 1, with a cross-sectional study design, 9826 students were recruited, and their knowledge of international PA recommendations, PA stage distribution, and self-reported PA level were surveyed. Pearson's χ2 test was used to test whether those participants who were aware and not aware of PA guidelines were equally distributed across the stages of PA behavior, and independent t test was conducted to test the group difference in the actual levels of PA. In Study 2, 279 students who were not aware of the PA recommendations were randomly allocated to either an intervention group or a control group, and only those in the intervention group were presented with international PA guidelines. In both groups, students' PA stages and PA level were examined before the test and then 4 months post-test. McNemar's test for correlated proportions and repeated-measures analysis of variance were conducted to examine the changes in PA stage membership and PA level after the intervention. ResultsStudy 1 results revealed that only 4.4% of the surveyed students had correct knowledge of PA recommendations. Those who were aware of the recommendations were in later stages of PA behavior (χ2(4) = 167.19, p < 0.001). They were also significantly more physically active than those who were not aware of the recommendations (t(443.71) = 9.00, p < 0.001, Cohen's d = 0.53). Study 2 results demonstrated that the intervention group participants who were at the precontemplation and contemplation stages at the pre-test each progressed further in the PA stages in the post-test (χ2(1) = 112.06, p < 0.001; χ2(1) = 118.76, p = 0.03, respectively), although no significant change in PA level was observed (t(139) < 1, p = 0.89). ConclusionThe results showed that awareness of the PA recommendations was associated with higher stages and levels of PA behavior, and a brief educational exposure to PA recommendations led to improved stages of PA behavior but no change in the levels of PA among Chinese college students. More effective public health campaign strategies are needed to promote the dissemination of the PA recommendations and to raise the awareness of the Chinese student population.

Efficacy of Combination of Motivational Interviewing and Cognitive Behavior Intervention with Substance Abuse Street Adolescents in India: A Randomized Control Study

This study assessed the efficacy of a 4-month program combining motivational interviewing and cognitive behavior intervention on substance-using street adolescents in India. The study followed classical experimental design and the subjects were randomly assigned to control and experimental groups. Readiness to change questionnaire and Adolescent Relapse Coping Questionnaire tools were used for the evaluation of the intervention program. At the baseline, majority of the respondents in both the groups were at the precontemplation stage of motivation. At the end of the 3rd month of the intervention, there was a significant difference, χ2 = 31.139, df = 2, p < .001, between the 2 groups on the stages of motivation. The study’s limitations are noted.