Stages Of Change Theory Research Articles

School Nurses' Role in Identifying and Referring Children at Risk of Noise-Induced Hearing Loss

Young people are likely to experience noise-induced hearing loss (NIHL), as the use of personal listening devices and other damaging factors (e.g., video games) increases. Little research has examined the role of school health personnel in the prevention and early identification of hearing impairment. A 32-item, valid and reliable survey was developed regarding elementary and middle school nurses' practices concerning hearing loss screening and prevention. The survey instrument was based on the Stages of Change theory and the Health Belief Model. A random sample of 800 nurses was obtained from The National Association of School Nurses. A two-wave mailing was used to achieve a 58% response rate. Forty eight percent indicated there were not many educational programs that addressed NIHL in students. Performing hearing screenings routinely can help identify those students at risk. School nurses need to become advocates for policies and programs that mandate hearing screenings and educational programs to help reduce hearing loss.

Reflections on 25 Years of Health Promotion—Where Have We Been and Where are We Going?

Reflections on 25 Years of Health Promotion—Where Have We Been and Where are We Going?

Facilitating Successful Aging: Encouraging Older Adults to Be Physically Active

Participation in regular physical activity has the potential to change the way we age. Evidence indicates that engaging in regular physical activity can provide dramatic physical, mental, and social benefits to older adults and decrease overall any-cause mortality. For older adults, the focus changes, and beside the promotion of health, maintenance of independent living becomes paramount. Nurse practitioners (NPs) must counsel older adults on the benefits of physical activity. The Stages of Change theory can be used to encourage older adults to change sedentary behavior and become more active.

Reducing Diabetes Risk among African American Women using Trained Peer Educators in a Church Setting

A pilot study was developed to evaluate the efficacy of peer‐led nutrition and lifestyle education based on the Stages of Change theory and the National Institutes of Health's Small Steps Big Rewards campaign on the risk of Type 2 diabetes in older adult African American (AA) women. Using a two condition (usual care and intervention) repeated measures (pretest, posttest, and follow‐up) design, the 8‐week intervention will educate AA women ages 45 and older at risk for Type 2 diabetes on the effects of dietary practices and physical activity (PA) on reducing risk of Type 2 diabetes. Outcome measures include body weight changes and diabetes‐related clinical indicators (total cholesterol, LDL, fasting blood glucose, and glycosylated hemoglobin (HbA1c)). We hypothesize that women receiving the program (intervention) from trained peer educators in a church setting will improve dietary practices and increase PA (number of steps walked), resulting in a decreased risk profile for Type 2 diabetes (baseline to follow‐up) compared to those not receiving the program (usual care). Women will receive educational handouts, developed for the project, a pedometer, and dietary and blood analysis results. Findings of this study will be used to further develop culturally relevant intervention strategies to prevent Type 2 diabetes among older adult AA women in community‐based settings. Supported by NCMHD/NIH 1P20MD002289‐01.

Factors Affecting the Choices Young People Make When Selecting Healthy Food: A Conceptual Model

ABSTRACT This study seeks to discuss the reasons why the youth make healthy food choices. It presents a conceptual model based on social cognitive theory, stages of change theory, and trans-theoretical theory for understanding factors that influence young people's dietary and health behaviour. This model purports to conceptualise eating behaviour as a function of individual and environmental influences.

Effects of a Stanol-Enriched Diet on Plasma Cholesterol and Triglycerides in Patients Treated with Statins

Background Plant stanols have been recommended in combination with individualized dietary interventions to reduce plasma cholesterol concentrations. It is unclear whether plant stanols in combination with dietary guidance in patients already using optimal doses of statins will further reduce fasting and postprandial lipids compared with standard care. Study Design This single-blind, randomized study investigated the effect of plant stanols in margarines, combined with a lipid-lowering dietary intervention, in patients already on lipid-lowering medications at maximal doses not reaching their target lipid levels. Nutrition education was based on the stages of change theory. The control group (which served as the standard care control group) was also taking optimal doses of statins. This group received a margarine without plant stanols and a leaflet with Dutch nutrition guidelines. Fasting lipids were measured once in venous samples and postprandial lipemia was assessed by self-measured triglycerides in an outpatient setting. All subjects were given a capillary triglyceride measuring device (Accutrend GCT, Roche Diagnostics, Mannheim, Germany) and were instructed to measure their capillary triglycerides at six fixed time-points throughout the day on three different days. The mean area under the triglyceride curve represented total daylong triglyceridemia, which has been shown to reflect postprandial triglyceridemia. Twenty patients were included, 11 in the intervention group and 9 in the control group. Results In the plant stanol group, low-density lipoprotein cholesterol decreased significantly by 15.6% compared with a reduction of only 7.7% in the control group. The daylong triglyceridemia was similar in both groups at the beginning and at the end of the study, and no change was observed by the intervention. Conclusion Intensive dietary intervention with addition of plant stanols results in clinically relevant reduction of low-density lipoprotein cholesterol in patients optimally treated with statins, compared with similar patients on statins receiving only standard care. The use of a plant stanol-enriched margarine did not decrease postprandial triglyceridemia in these patients.

Cultural Relevancy of a Diabetes Prevention Nutrition Program for African American Women

Diabetes among African American women is a pressing health concern, yet there are few evaluated culturally relevant prevention programs for this population. This article describes a case study of the Eat Well Live Well Nutrition Program, a community-based, culturally specific diabetes prevention nutrition program for African American women. The stages of change theory and principles from community organization guided the development of the program. Health education strategies, including participatory development and program delivery by peer educators, were applied to promote cultural relevance. Results indicated that overall participants (90%) believed the program to be culturally relevant and were very satisfied with the program (82%). Cultural relevancy was significantly associated with greater program satisfaction and changes in dietary patterns when controlling for the number of sessions attended. Conclusions suggest that participatory strategies can be effective in designing culturally specific prevention programs for African American women.

The Health Compliance Model-II.

The Health Compliance Model-II (HCM-II) is posited to address the multivariate, dynamic, and idiosyncratic nature of predicting adherence to health behaviors. The HCM-II advances upon the original Model (E.M. Heiby & J.C. Carlson, 1986) by emphasizing emotional causal variables indicated by a psychological behaviorism framework (A.W. Staats, 1996). The HCM-II also adds causal variables from the empirical support of eclectic cognitive-behavioral models: Social Cognitive Theory (A. Bandura, 1991); Modified Social Learning Theory (K.A. Wallston, 1992); Health Belief Model (I.M. Rosenstock, 1991); and Theories of Reasoned Action/ Planned Behavior (M. Fishbein & I. Ajzen, 1975). Preliminary development of an assessment instrument derived from the proposed HCM-II is described and implications for treatment and prevention of noncompliance are discussed. Keywords: health compliance model-ii, psychological behaviorism, adherence, health behaviors. ********** Noncompliance or nonadherence to common healthy life-style recommendations has been subject to intense scrutiny by the behavioral health research community in recent years. Now that medical advances of the 20th century have brought many formerly fatal, acute illnesses under control (Myers & Midence, 1998), public health attentions focus more closely upon the promotion of self-controlled prevention and treatment of chronic medical conditions. However, after more than 30 years of research and intervention, poor compliance statistics with mainstream health behavior recommendations is cause for national concern (Conner & Norman, 1996). This predicament is reflective of shortcomings within popular theoretical models used to explain and predict compliance to heath behaviors. Despite a large empirical literature, there is still no consensus as to the superiority of any theory or model, or even that particular variables are more useful than others for understanding the determinants of compliance within discrete behavioral health domains (Weinstein, 1993). One exception is an operant behavioral analysis that for decades has been shown to effectively guide treatment in environments where discriminative stimuli and contingent reinforcement can be controlled (e.g., daCosta, Rapoff, Lemanek, & Goldstein, 1997; Haynes, Sackett, Gobson, Taylor, Hackett, Roberts, & Johnson, 1976). Given that environmental engineering is usually not feasible, most compliance enhancement theories focus on an eclectic variety of cognitive-behavioral health compliance competency variables. We describe the Health Compliance Model-II (Frank, 2000; Heiby & Frank, 2003; Heiby & Lukens, in press) as an attempt to move toward a unification and expansion of the operant behavioral and cognitive-behavioral theoretical and empirical compliance enhancement literatures. [FIGURE 1 OMITTED] There are several reviews of cognitive-behavioral compliance theories (e.g., Horne & Weinman, 1998; Myers & Midence, 1998; Norman & Conner, 1996; Weinstein, 1993). In Figure 1, we summarize the variables proposed in these theories that enjoy substantial empirical support, so not all posited variables in each theory are listed. The transtheoretical or stages of change theories have not been included in Figure 1 because they describe the options of change rather than the posit conditions and skills involved in acquiring behavioral health regimens (e.g., as suggested by DiClemente, 1993, p. 105). The theories are presented in approximate chronological order from right to left. While the number of empirically supported variables included in theories increase over time, it is apparent that no theory has fully integrated the contributions of prior theories. Weinstein (1993) argued that a more comprehensive theory of compliance is needed, and issued the following appeal to the research community for ongoing model development: Because these theories contain at least a grain of truth, empirical tests typically yield some degree of confirmation, enough to keep the theory under scrutiny from being rejected . …

W04.147 Plant sterol and stanol esters do not influence markers for endothelial function and inflammation in subjects on statin treatment despite a significant reduction in LDL cholesterol

Plant stanols have been recommended in combination with individualized dietary interventions to reduce plasma cholesterol concentrations. It is unclear whether plant stanols in combination with dietary guidance in patients already using optimal doses of statins will further reduce fasting and postprandial lipids compared with standard care.This single-blind, randomized study investigated the effect of plant stanols in margarines, combined with a lipid-lowering dietary intervention, in patients already on lipid-lowering medications at maximal doses not reaching their target lipid levels. Nutrition education was based on the stages of change theory. The control group (which served as the standard care control group) was also taking optimal doses of statins. This group received a margarine without plant stanols and a leaflet with Dutch nutrition guidelines. Fasting lipids were measured once in venous samples and postprandial lipemia was assessed by self-measured triglycerides in an outpatient setting. All subjects were given a capillary triglyceride measuring device (Accutrend GCT, Roche Diagnostics, Mannheim, Germany) and were instructed to measure their capillary triglycerides at six fixed time-points throughout the day on three different days. The mean area under the triglyceride curve represented total daylong triglyceridemia, which has been shown to reflect postprandial triglyceridemia. Twenty patients were included, 11 in the intervention group and 9 in the control group.In the plant stanol group, low-density lipoprotein cholesterol decreased significantly by 15.6% compared with a reduction of only 7.7% in the control group. The daylong triglyceridemia was similar in both groups at the beginning and at the end of the study, and no change was observed by the intervention.Intensive dietary intervention with addition of plant stanols results in clinically relevant reduction of low-density lipoprotein cholesterol in patients optimally treated with statins, compared with similar patients on statins receiving only standard care. The use of a plant stanol-enriched margarine did not decrease postprandial triglyceridemia in these patients.

Review of Current Health Education Theories

This article presents a review of current theories and models in health education. Articles published in 2003 in the American Journal of Health Education, the American Journal of Health Behavior, Health Education and Behavior, Health Education Research, and the International Electronic Journal of Health Education, were reviewed. Concepts and constructs for each theory and model used are presented. The three predominant theories and models in this literature, The Transtheoretical Model (Stages of Change Theory), the Theory of Reasoned Action/Planned Behavior, and the Social Cognitive Theory are examined in greater detail.

HIV Prevention Among High-Risk and Hard-to-Reach Rural Residents

HIV infection and HIV risk behaviors are primarily considered to be urban problems. However, rural areas are also experiencing HIV. Because the criminal justice system has a disproportionate number of persons at high risk for HIV, rural probationers were targeted. This article (1) describes an intervention designed to change the high-risk drug use and sexual behaviors of rural residents on probation; and (2) presents information on 200 rural probationers who entered a project to reduce drug use and risky sex. After informed consent was obtained, participants were randomly assigned to either the NIDA standard HIV intervention or a “rural-focused” HIV intervention that incorporates the NIDA intervention as well as thought mapping and structured stories. The rural focused intervention is grounded in the Stages of Change theory and motivational interviewing. Initial findings indicate that participants reported high levels of lifetime illicit drug use and risky sexual behaviors. Participants also reported limited knowledge about protection from HIV and hepatitis. These findings suggest that the project is reaching a group of rural residents who engage in high-risk drug and sexual behaviors.

Assessment of Physical Activity, Exercise Self-Efficacy, and Stages of Change in College Students Using a Street-Based Survey Method

This study assessed the level of physical activity, exercise self-efficacy, and stages of change for exercise behavior among college students at a large midwestern university using a street-based survey method. The 50% response rate produced 925 student responses comprising 95% as young (≤24 years of age), 53% female, and 79% Caucasian. One-third of the students did not participate in vigorous physical activity (≤3 days/week). Based on the stages of change questionnaire, 41% of the women and 35% of the men reported they were in the precontemplation or contemplation stages, as they were not active or were not exercising on a regular basis (≤3 times per week for 20 min or longer). Exercise-self efficacy scores were significantly different as a function of exercise stage as predicted by the stages of change theory (R2=0.26, P<.0001). These results are consistent with earlier reports on college students and their level of physical activity. Therefore, the low cost, ease of data collection, and the short turnaround for availability of results support the usefulness of a street-based survey of young adults on a college campus to evaluate physical activity.

Continuing education quiz: Revisiting Prochaska and DiClemente's stages of change theory: An expansion and specification to aid in treatment planning and outcome evaluation (freeman & dolan, pp. 224–234)

Continuing education quiz: Revisiting Prochaska and DiClemente's stages of change theory: An expansion and specification to aid in treatment planning and outcome evaluation (freeman & dolan, pp. 224–234)

Revisiting prochaska and DiClemente's stages of change theory: An expansion and specification to aid in treatment planning and outcome evaluation

Why people change and why they do not change is a question that therapists have asked for many years. For almost two decades one model of change has stood as the standard bearer in conceptualizing the stages of change in therapy. The need to modify the Prochaska and DiClemente model of change has come out of our own experiences in working with patients with a variety of mental health issues. The addition of these new stages reflects the experiences of clients and therapists both in and out of the therapeutic process. The original model has guided not only our therapy but our research as well. We now face times of increasing scrutiny of our therapeutic process and a reliance on research-based outcome evaluation. This increased scrutiny requires us to provide models with more precision to truly describe what we do and how we do it. The development of this expanded model of change was designed to fulfill that very purpose of more precision. This model will hopefully provide the clinician, the researcher, the third party payer and ultimately the patient with a more experience-centered focus from which to make their decisions.

Stages of change theory and the nicotine-dependent client: direction for decision making in nursing practice.

Clinical practice is the basic purpose of nursing. Nursing's evolving professional development calls for the application of theory to direct decision making in nursing practice. Therefore, in an attempt to bridge what has been described as the "theory-practice gap," the author demonstrates how Prochaska and DiClemente's stages of change theory is relevant to nursing practice. According to Prochaska and DiClemente, behavioral change, such as smoking cessation, involves a process of five identified stages: precontemplation, contemplation, preparation, action, and maintenance. The author discusses each stage of change and the framework it provides for decision making in nursing practice. The concept of relapse is described and highlighted as a valuable learning experience. Finally, using the criteria set by Chinn and Kramer, systematic evaluation of the stages of change theory pinpoints strengths and discusses integration of the theory into nursing practice.

A comprehensive smoking cessation programme after surgery increased 1 year quit rates

Simon JA, Solkowitz SN, Carmody TP , et al. Smoking cessation after surgery. A randomised trial. Arch Intern Med 1997 Jun 23; 157 : 1371 –6. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] To...

Staging of adult smokers according to the transtheoretical model of behavioural change: analysis of an eastern Ontario cohort.

1) To describe the distribution of adult smokers in an existing cohort according to stages of change theory; and 2) to compare movements of these smokers through the stages of change. Secondary analysis of existing cohort data. Eastern Ontario. Adult smokers who: 1) enrolled in a Quit & Win Challenge, or 2) received smoking cessation information (Quit Kit) from their area health unit, or 3) were randomly selected by telephone survey. 706 smokers were recruited and followed for one year. Only 2% of the adult smokers selected by random telephone survey were in the "action" stage at baseline, compared with 14% of the Quit and Win Challenge participants, and 14% of the Quit Kit recipients. Variations in movement through the stages of change were observed between groups upon follow-up. The results suggest a need to use stage-matched approaches when developing population-based smoking cessation interventions.

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.

A measure of stages of change in fruit and vegetable consumption among fourth- and fifth-grade school children: reliability and validity.

We developed, pilot-tested, and field-applied a stages of change questionnaire regarding fruit and vegetable (F&V) consumption among fourth- and fifth-grade students. The design included cross-sectional assessment of internal consistency and construct validity, and 2-week and 7-week longitudinal assessment of test-retest reliability. Subjects included 134 students from one school for pilot-testing and 252 from two schools for field application. Thirty-two questions from McConnaughy et al's stages of change questionnaire were adapted and pilot-tested; minor revisions were made for field application. Statistical analyses included principal components analysis to identify subscales; cluster analysis to identify subgroups within students; Cronbach's alpha coefficient to assess internal consistencies; Pearson product-moment correlations to assess test-retest reliabilities; and oneway ANOVA's by F&V stages of change clusters with actual F&V consumption, F&V self-efficacy subscales, F&V preferences, and F&V outcome expectations subscales to determine construct validity. Principal components analysis from the field application indicated two subscales (precontemplation and beyond precontemplation) accounting for 39.5% of variance. Cluster analysis indicated 6 interpretable clusters; 2 (n = 63) provided responses inconsistent with the stages of change theory and 4 (n = 189) provided responses consistent with the theory. Internal consistencies and test-retest reliabilities were acceptable. Students in the "beyond precontemplation" clusters had higher levels of self-efficacy and outcome expectations regarding eating F&V. Measuring stages of change other than the precontemplation stage in F&V consumption among elementary school children is problematic. Perhaps the theoretical concept does not apply to children, or elementary school children lack the ability to comprehend the questions measuring the concept, or the approach used was not entirely appropriate.