The Transtheoretical Model Stages Research Articles

Examining Help-Seeking Behavior in People Living Alone With Cognitive Impairment.

More than 4 million people in the United States live alone with cognitive impairment or early dementia, yet research on their experiences is limited. Previous research has shown this population has higher levels of unmet care needs and lower financial resources than their married peers. By exploring the experiences of people living alone with cognitive impairment (PLACI), this research examines the successes and barriers within their journey to inform how interventions can improve their quality of life. We conducted qualitative interviews with 15 PLACI (median age 69, 87% white, and 80% female) to explore perceptions of future care needs and resources. Through a modified ideal-type analysis, participants' thought processes and actions regarding help-seeking were mapped to the five stages of the transtheoretical model. These perspectives suggest opportunities such as connecting them to community social work that could help facilitate their understanding of their needs, help them identify resources, and promote proactive aging.

Systematic Review of CBT Techniques and their Alignment with the Transtheoretical Model Stages of Change

<p dir="ltr"><span>Cognitive-behavioral therapy (CBT) encompasses a diverse range of techniques designed to facilitate behavior change. Evaluation of these techniques through the transtheoretical model (TTM) may provide insight into their effectiveness and the progressive nature of change in individuals with substance use disorders and the gradual nature of change in individuals with substance use disorders. This systematic review aims to identify and evaluate the methods and techniques used in CBT and examine their relationship to the stages of change as defined by the Transtheoretical Model (TTM). A comprehensive search of databases such as PubMed, PsycINFO, and the Cochrane Library was conducted, focusing on studies published between 2000 and 2023. The review focused on peer-reviewed articles that examined CBT (cognitive behavioral therapy) techniques and their alignment with stages of transformation. especially the transtheoretical model (TTM), in the context of substance use disorders. The review identified several CBT techniques, including cognitive restructuring, mindfulness, problem solving, and skills training. These techniques have been found to align with the various stages of the TTM and effectively promote progression through the stages of change, particularly in facilitating the transition from contemplation to preparation and from action to maintenance. The integration of CBT techniques with the TTM stages of change offers a structured approach to behavioral modification in substance use disorders. Understanding and applying these techniques within the TTM framework can enhance the efficacy of interventions.</span></p><div><span><br /></span></div>

Assessment of Personalized Exercise Prescriptions Issued by ChatGPT 4.0 and Intelligent Health Promotion Systems for Patients with Hypertension Comorbidities Based on the Transtheoretical Model: A Comparative Analysis.

Exercise is a vital adjunct therapy for patients with hypertension comorbidities. However, medical personnel and patients face significant obstacles in implementing exercise prescription recommendations. AI has been developed as a beneficial tool in the healthcare field. The performance of intelligent tools such as ChatGPT 4.0 and Intelligent Health Promotion Systems (IHPS) in issuing exercise prescriptions for patients with hypertension comorbidities remains to be verified. After collecting patient information through IHPS hardware and questionnaire systems, the data were input into the software terminals of ChatGPT 4.0 and IHPS according to the five stages of the Transtheoretical Model, resulting in exercise prescriptions. Subsequently, experts from various fields scored the accuracy, comprehensiveness, and applicability of each prescription, along with providing professional recommendations based on their expertise. By comparing the performance of both systems, their capability to serve this specific group was evaluated. In most cases, ChatGPT scored significantly higher than IHPS in terms of accuracy, comprehensiveness, and applicability. However, when patients exhibited certain functional movement disorders, GPT's exercise prescriptions involved higher health risks, whereas the more conservative approach of IHPS was advantageous. The path of generating exercise prescriptions using artificial intelligence, whether via ChatGPT or IHPS, cannot achieve a completely satisfactory state.But can serve as a supplementary tool for professionals issuing exercise prescriptions to patients with hypertension comorbidities, especially in alleviating the financial burden of consulting costs. Future research could further explore the performance of AI in issuing exercise prescriptions, harmonize it with physiological indicators and phased feedback, and develop an interactive user experience.

Personalizing travel behaviour change interventions using the trans-theoretical model and multimodality data

IntroductionBehaviourally informed soft policies, such as nudges, have become popular in areas like health, environment, and energy use as cost-effective instruments to change behaviour and decision-making. However, the effectiveness of soft policies in the transport sector is modest at best. One reason for this relative ineffectiveness might be their one-size-fits-all nature, and personalizing soft interventions has been suggested to increase their effectiveness. The Trans-theoretical Model (TTM) suggests that people progress through five stages of behavioural change, from pre-contemplating a behaviour to maintaining the behaviour, and behavioural interventions could be designed for specific stages. However, it is not always feasible to conduct surveys to place people at different stages of the TTM.MethodsThis paper explores whether it is possible to use multimodality data taken from a travel diary to place people at different stages of the TTM. The analysis uses an existing dataset from 826 respondents that includes self-reported TTM stages regarding cycling and data on multimodality. In the analysis, the multimodality data are used to allocate respondents to categories and assign them to TTM stages. The performances of the stage assignment approaches are evaluated using the self-reported TTM data and confusion matrices.FindingsThe accuracy of the allocation of participants to TTM stages using multimodality data is approximately 75%. The accuracy is higher for early stages (pre-contemplation) and later stages (maintenance) of the TTM. A data-driven approach to dealing with multimodality data performs slightly better than an approach that relies on pre-defined categorization.ConclusionThe paper suggests that it will be possible in the future to personalise behavioural interventions according to the stages of the TTM even in the absence of self-reported survey data that classifies people to TTM stages if objective multimodality data are available.

Paper-based and mobile application-based self-monitoring tool for healthy dietary intake, development and applicability: a non-randomized trial

BackgroundUnhealthy diet is a key risk factor for Non-Communicable Diseases (NCDs) that contribute to increased morbidity and premature mortality. With increased computer literacy and mobile phone penetration, there is a high opportunity for mobile application-based interventions. The current study was conducted to develop a mobile application to monitor dietary intake and to assess its acceptability and effectiveness in diet control compared to a similar paper-based intervention.A mobile application was developed based on research evidence and opinions of local experts. The mobile application was introduced to a selected group of office workers who were in preparation, action, and maintenance stages of the Trans Theoretical Model (TTM) and a paper-based intervention was used as the comparator. Socio-demographic data were collected through a self-administered questionnaire. Participants were followed up for three months for adherence. The effectiveness of interventions was assessed at the end of three months by comparing the progressive change in the stage of change and the change from unhealthy to healthy dietary intake between two groups as primary and secondary outcomes respectively.ResultsAmong 123 office workers who participated in the study, 19.5% preferred the mobile intervention over the paper-based intervention. Younger, unmarried office workers and those who do not have children, had a higher acceptance for the mobile intervention (p < 0.05). There was no difference in adherence (in all three months) or outcomes between the two groups of intervention.Conclusion and recommendationsMobile application-based interventions are better accepted among the young age group and further studies are recommended to explore their applicability.Trial registrationThe study was registered in the Sri Lankan Clinical Trial Registry (Registration No. SLCTR/2020/025; Date 15th December 2020).

Role of Individual Environmental Consciousness in Industrial Decarbonization Transition

Decarbonization leads to significant transition processes in industrial companies with the aim of achieving sustainable production. The consequences are far-reaching and can affect, among other things, the workplace and the activities of the employees. The readiness for change among employees is seen as a central success factor for the success of the transition to sustainable production. However, it has been unclear to what extent the environmental consciousness of individual employees influences how open employees are to this transition. A total of 427 employees from a company in the steel industry, currently undergoing a transition aimed at sustainable production, were surveyed. It was found that affective environmental consciousness influences the stages of the Transtheoretical Model in which employees find themselves regarding the company’s transition. The results emphasize, among other things, the importance of encouraging individual environmental consciousness in decarbonization transitions for the successful management of these transitions.

The potential and limitations of large language models in identification of the states of motivations for facilitating health behavior change.

The study highlights the potential and limitations of the Large Language Models (LLMs) in recognizing different states of motivation to provide appropriate information for behavior change. Following the Transtheoretical Model (TTM), we identified the major gap of LLMs in responding to certain states of motivation through validated scenario studies, suggesting future directions of LLMs research for health promotion. The LLMs-based generative conversational agents (GAs) have shown success in identifying user intents semantically. Little is known about its capabilities to identify motivation states and provide appropriate information to facilitate behavior change progression. We evaluated 3 GAs, ChatGPT, Google Bard, and Llama 2 in identifying motivation states following the TTM stages of change. GAs were evaluated using 25 validated scenarios with 5 health topics across 5 TTM stages. The relevance and completeness of the responses to cover the TTM processes to proceed to the next stage of change were assessed. 3 GAs identified the motivation states in the preparation stage providing sufficient information to proceed to the action stage. The responses to the motivation states in the action and maintenance stages were good enough covering partial processes for individuals to initiate and maintain their changes in behavior. However, the GAs were not able to identify users' motivation states in the precontemplation and contemplation stages providing irrelevant information, covering about 20%-30% of the processes. GAs are able to identify users' motivation states and provide relevant information when individuals have established goals and commitments to take and maintain an action. However, individuals who are hesitant or ambivalent about behavior change are unlikely to receive sufficient and relevant guidance to proceed to the next stage of change. The current GAs effectively identify motivation states of individuals with established goals but may lack support for those ambivalent towards behavior change.

Application of the Transtheoretical Model to Physical Activity and Health-related Quality of Life Among Older People Living With Frailty in the Community: The Fitness and Nutrition Program for Seniors (FANS) Study Protocol

Background: When the COVID-19 pandemic is combined with frailty, not only are older people's types of activities and willingness to be active limited, but also issues and hidden concerns about health care arise. However, the effectiveness of health promotion strategies incorporating remote care technologies remains to be explored. Therefore, the purpose of this study was to develop a hybrid learning approach based on a fitness and nutrition program for seniors (FANS). Simultaneously, the FANS follows the Transtheoretical Model (TTM) as an overall framework to design blended learning in in-person and telecare modalities for older people living with frailty in the community.Methods: This study is a non-randomized, control-group, pretest–posttest design. A total of 84 older participants living with frailty will be assigned to two groups. The intervention group will receive the 6-month, 9-session FANS through hybrid learning, which includes in-person physical activity (PA) training, nutritional guidance led by a nurse, and group discussions. The official account of the FANS and the group chat will provide individuals with online home practice at the current TTM stage, session time and home practice reminders, video reviews, consultations, and tutoring for telecare. The waitlist control group will maintain regular health promotion activities. Three repeated assessments (one pre-test and two post-training tests conducted after 3 months and after 6 months) will be conducted. The primary outcome measures will include frailty status, PA, and health-related quality of life (HRQoL), and the secondary outcome measures will be health-related data. Statistical analysis will include the Chi-squared test, Independent Sample t-test, and Generalized Estimating Equation (GEE).Discussion: This study will provide evidence that the FANS for older people living with frailty will have more positive and beneficial outcomes than the traditional method. Simultaneously, we hope the FANS will help the older population living with frailty in the community to transform their health difficulties in the future.Trial Registration: NCT05242549. Registered 22 February 2022.

Relationship between the behavior change model and salt intake in hypertensive patients: a single non-specialized hypertension clinic prospective observational study.

We investigated whether changes in salt reduction readiness are associated with changes in estimated daily salt intake and blood pressure (BP). We divided 86 hypertensive patients into groups with high and low readiness for salt-reducing behavior [an up (UP) and a down (DN) groups, respectively] based on the transtheoretical model (TTM) over a 12-month observation period. We then investigated the relationships between changes in the TTM stage and changes in daily salt intake and BP over 12 months. The patients in the UP group had significantly increased urine potassium concentrations (from 51.2 ± 23.3 mEq/L at baseline to 56.9 ± 25.5 mEq/L at 12 months; P = 0.048) and significantly decreased estimated 24-h urinary salt excretion (from 9.7 ± 2.9 g/day at baseline to 8.4 ± 2.8 g/day at 12 months; P = 0.045). In addition, they also had significantly lower changes in urine sodium concentration (-13.1 ± 46.1 vs. -6.6 ± 59.7 mEq/L; P = 0.048), significantly increased changes in urine potassium concentration (5.7 ± 20.1 vs. -4.8 ± 28.6 mEq/L; P = 0.030), and significantly decreased changes in estimated 24-h urinary salt excretion (-1.3 ± 2.6 vs. -0.1 ± 2.6 g/day; P = 0.045) compared with patients in the DN group. However, their home BP did not improve over 12 months. The hypertensive patients who increased their readiness or maintained a high readiness for salt reduction over 12 months showed a significant increase in daily potassium intake and significant decrease in daily salt intake.

Smoking Status and factors influencing Smoking Cessation among primary school parents: A Cross-sectional study

Objective: This study aims to determine smoking status among primary school parents and identify factors influencing smoking cessation. Additionally, the study seeks to increase awareness about the transtheoretical model and examine its role in the smoking cessation process. Materials and Methods: The study was conducted with 2,354 parents of students from a primary school in Konya. Participants completed surveys assessing smoking status, attitudes towards quitting, and levels of awareness. Factors related to smoking status, including age, gender, education level, occupation, and alcohol use, were analyzed. Smokers quit attempts were associated with the stages of the transtheoretical model, and whether they sought professional help was evaluated. Results: Of the participants, 33.1% (n=780) were smokers. The average age of smokers was 36.6±4.61, and the frequency of smoking was higher among men than women. 39% of the participants were low-level smokers. Significant associations were observed between smoking status and factors such as age, gender, education level, occupation, and alcohol use (p&lt;0.001). The majority of smokers attempted to quit using the "sudden cessation" method, with a low rate of seeking professional help. Most of those who successfully quit also used the "sudden cessation" method. 31.4% of participants had never attempted to quit smoking. As the number of quit attempts increased, participants were observed to become more prepared to quit smoking (p&lt;0,001). According to the transtheoretical model, most individuals were in the precontemplation stage. Conclusion: The frequency of smoking is higher among men and decreases as education level increases. Most participants attempted to quit smoking on their own, with a low level of seeking professional help. Multiple attempts to leave have been shown to increase the likelihood of success, and awareness of the harms of passive smoking has significantly influenced smoking behavior.

Oral Cancer Hazards Related to Tobacco Use and a Transtheoretical Model Assessment of Preparedness of Individuals With Oral Potentially Malignant Disorders to Quit Tobacco Use.

Objectives There is a lack of knowledge on oral cancer and oral potentially malignant disorders (OPMDs) among the local communities of Northeast India. Since the habit of tobacco is linked to the culture and oral cancer is a widespread epidemic here, it is pertinent to assess the knowledge about risk factors and readiness to quit the habit among the study population. Methods The present research was done in the Tobacco Cessation Centre (TCC), Department of Public Health Dentistry (PHD) of Regional Dental College (RDC), Guwahati, Assam, from Jan 2023 to June 2023. This cross-sectional research was done among 200 patients aged 15-65 years. We have utilised the transtheoretical model (TTM) for assessing behaviour change. Oral inspection using a mouth mirror and explorer with adequate illumination was used to visualise the lesions. Data was collected through a self-administered questionnaire. Chi-square and odds ratio (OR) tests were used to see the association among the variables. The data was analysed with Microsoft Excel (Microsoft Corporation, Redmond, Washington) and IBMSPSSStatistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States).A p-value less than 0.5 is considered to be statistically significant. Results Of the 200 participants, 64(32%) had some oral lesions linked to tobacco use. A significant correlation was observed between the oral lesions and TTM stages (OR=2.81, p<0.05). Among the participants, most were aware only of tobacco (68%) and quid chewing (58%) practices as risk reasons for developing oral cancer. Conclusion The study participants' awareness of OPMDs, their health risks, and clinical signs and symptoms could be higher. A significant relationship was seen between OPMDs and TTM behavioural stages.

Stages of Change toward Meat Reduction: Associations with Motives and Longitudinal Dietary Data on Animal-Based and Plant-Based Food Intakes in French Adults

BackgroundReducing meat consumption is advocated for healthier and more sustainable diets. However, behavioral studies are needed to better understand the mechanisms underlying meat-reducing dietary changes. ObjectivesThe main aim of this study was to compare the motives associated with stages of change toward meat reduction in French adults, using the transtheoretical model (TTM). A second aim was to investigate the associations between stages of change and adherence to dietary patterns favoring a better balance of animal and plant food consumption over time. MethodsThis longitudinal study included 25,143 non-vegetarian participants of the web-based NutriNet-Santé cohort with a mean follow-up of 6.2 (SD = 2.6) y. Dietary data were obtained from 24-h dietary records over the period 2009–2019. The contribution of meat to total energy intake and scores measuring the contribution of healthy and unhealthy plant-based foods to the diet were computed. A questionnaire completed in 2018 allowed us to identify the TTM stages of change related to meat reduction (precontemplation, contemplation, preparation, action, and maintenance), and recorded motives related to meat consumption. We used multivariate linear mixed models for repeated data to assess associations between food intake changes and stages, and logistic regression for motives, presented as adjusted frequencies. ResultsParticipants in later stages were characterized by a significantly higher decrease in meat intake over time, compared with the earliest stage (for example, βmaintenance ∗ time = −0.08, P < 0.0001), and a higher increase in the healthy plant-based food consumption score over time (for example, βmaintenance∗time = 0.11, P < 0.0001). Concerns about health, nutrition, and the environment were the most frequently cited motives for reducing meat consumption at all stages. ConclusionsIndividuals who had already initiated meat reduction adhered to healthier and more sustainable diets than meat continuers. Characterizing motives according to readiness to reduce meat consumption could support tailored public health campaigns. Trial registration numberThe study protocol is registered at clinicaltrials.gov with Clinical Trial Registry number NCT03335644 available at https://clinicaltrials.gov/ct2/show/NCT03335644.

Breast Cancer Knowledge and Mammography Use Among Asian American Women Aged 40 and Older: Using the Transtheoretical Model Approach.

Mammography screening rates remain low among Asian American women (AAW). The aims of our study were to: (a) assess breast cancer knowledge and mammography screening behaviors, and (b) identify the factors related to the transtheoretical model (TTM) stages of change in relation to mammography utilization among AAW aged 40 and older. Using a cross-sectional design, a convenience sample of 714 AAW completed a structured questionnaire in 2021. Participants demonstrated a moderate level of knowledge regarding breast cancer and mammography. Only 34.2% of the participants reported obtaining regular mammograms. The ordinal logistic regression indicated that age, birthplace, health perception, breast biopsy history, breast cancer knowledge, self-efficacy, and perceived barriers were correlated with TTM stages of change. Our results highlight the need for implementing effective interventions aimed at increasing knowledge and screening rates for breast cancer among AAW. Additional TTM studies with AAW are needed to determine the relationships among TTM constructs and develop theory-based programs to improve adherence to screening guidelines. Future research using a mixed-method design may provide opportunities to explore complex phenomena associated with breast cancer screening behaviors. Finally, further assessments of the Breast Cancer Knowledge Scale's psychometric properties are necessary to improve this instrument.

Breakfast Eating in Elementary School Students in Jiroft, Iran: An Application of Transtheoretical Model

Background: Breakfast is a very important meal. It can either make or break your day, and it can be a daunting task. Objectives: We used the transtheoretical model (TTM) to assess the trend of breakfast eating among elementary school students in Jiroft city, Iran. Methods: In this descriptive‑analytic research, 290 elementary school students in Jiroft city were selected using stratified sampling. Data were collected using a questionnaire to assess breakfast eating trends according to TTM. The data were analyzed using SPSS version 16. Results: Approximately 9.3% of the participants were in the precontemplation stage, 21.7% in the contemplation stage, 7.2% in the action stage, 53.4% in the preparation stage, and 8.3% in the maintenance stage. There was a significant relationship between TTM constructs and stages of change in breakfast consumption 2 or more times a week. Moving from the precontemplation stage to the maintenance stage was associated with an increase in decisional balance, processes of change, and self‑efficacy (P &lt; 0.05). Conclusions: It is suggested to emphasize the importance of perceived benefits and greater self-efficacy in the design of educational interventions based on this model, increase the use of change processes, and decrease the perceived barriers as much as possible to establish correct behaviors.

Transtheoretical model of behavior change and motivational profiles among University of Baguio students using fitness applications

Introduction: This study aims to determine how the motivational profile affects the behavior change of fitness application users in terms of adopting regular physical activity. Methods: The study utilized a descriptive correlation method design to determine the variations of the motivational regulations of fitness application users. A total of 204 college students were respondents, wherein 57 were male, and 147 were female. Respondents were of legal age, undergraduates, and have used or are using physical fitness applications. Respondents answered the questionnaire online in their free time. Data collected were subjected to tabulation, averaging, and Fisher’s Exact Test. Results: The study found no noticeable difference between genders in terms of the motivational regulations comprising their motivational profile and the distribution of users along the stages of the Transtheoretical Model of Behavior Change. Intrinsic and identified regulations were found to be high amongst the respondents (Intrinsic = 5.62; Identified = 5.31), while their external regulation was low (External = 2.51). Data suggest that the motivational profile of fitness application users is found to be autonomous. Moreover, there is a highly significant relationship between identified regulation and exercise behavior change along the preparation or action stages (p = 0.001). A significant relationship between intrinsic regulation and the preparation or action stage of exercise behavior change is also established (Fisher’s Exact Test, p = 0.016). Discussion: The motivational profiles of fitness application users are favorable in adopting regular physical activity. Promotion and encouragement of the established autonomous motivational profile can help people seriously consider starting exercise as it increases one’s likelihood of sustaining interest and motivation to achieve and maintain higher stages of exercise behavior.

A Conceptual Framework Analysing Malaysian University Students’ Solid Waste Minimisation Behaviour: An Integrated Model

The magnitude of the global waste crisis highlights the urgent need for its mitigation. In Malaysia, consumer solid waste generation significantly contributes to the proliferation of municipal solid waste. University students, as a subset of the youth demographic, are considered the future gatekeepers of environmental preservation and sustainability. The present study proposes a conceptual framework that integrates the Transtheoretical Model (TTM) and Identity Theory to analyse solid waste minimisation behaviour among university students in Malaysia. The framework postulates that student behaviour varies across five TTM stages. The primary aim is to investigate the significance of pro-environmental self-identity (PESI) as an underlying motivation at various stages of the TTM. Besides behavioural adoption, the proposed framework emphasises the maintenance aspect of the behaviour, along with possible relapse effect. The knowledge generated from this study could be utilised by both policymakers and intervention planners to create student segmentation for a more streamlined behavioural change and Campaign, Education, Public Awareness (CEPA) effort. The present study supports the Sustainable Development Goal (SDG) 12 (Sustainable Consumption and Production) target and the green growth goals outlined in the Twelfth Malaysian Plan 2021–2025.

Prevalence of Alcoholism in Adolescents in Durango City, México; And the Stages of the Transtheoretical Model of Change

Prevalence of Alcoholism in Adolescents in Durango City, México; And the Stages of the Transtheoretical Model of Change

P08-09 The promotion of walking through nudging. Evaluation of the app „Time2Walk“

BackgroundWalking is an appropriate mode to increase or maintain the physical activity behavior. However, physically inactive adults often need support in order to increase their physical activity level. The aim of the presentation is to inform about the nudging framework within the app Time2Walk, the recruitment of the study participants for both time points, and the development of the walking behavior over time.MethodsThe study participants were recruited via social media, press releases, advertising material and personal contacts. A pre-post single group study design was applied using an online questionnaire before and after the intervention.The intervention refers to a not so distant dystopian future where the city Graz (Austria) suffers from pollution, traffic chaos as well as climate change. Via regular walking as well as visiting places such as parks or other points of interest the users of the app were rewarded with tokens and could contribute to reversing the pollution. Four different types of behavioral nudges were applied during the use of Time2Walk in order to motivate people to walk more: awareness-raising (information about health and traffic related effects), social (information about guided walking tours), rewarding (token-based rewards), and stabilizing (daily walking targets) nudges.The app was developed as a central hub for conveying the nudges and for raising the players' awareness. By means of Wilcoxon-tests, changes in behavior categories were investigated.ResultsThree hundred and forty seven people registered and 145 (42%) filled in the first questionnaire: 65% women, mean age 32 years (SD ±11) and 57% > high-school certificate. Of those, 31 (21%) filled in the the questionnaire a second time. Based on the stages of the Transtheoretical Model as well as on subjective assessment of the weekly walking behavior participants significantly raised their frequency of walking (20% increased walking from 4 or less days/week to ≥ 5 days/week).ConclusionsDifferent interdisciplinary expertise is essential for the development of the app-prototype including the nudging framework. Despite push-notifications, reminders through the newsletter and social media the response rate was low. In general, the nudging framework was successful in the increase of the perceived walking behavior.

Stages of a Transtheoretical Model as Predictors of the Decline in Estimated Glomerular Filtration Rate: A Retrospective Cohort Study.

BackgroundThe transtheoretical model (TTM) is composed of the multiple stages according to patient’s consciousness and is believed to lead people to realize the importance of healthier behaviors. We examined the association of TTM stages with the decline of estimated glomerular filtration rate (eGFR).MethodsWe used the annual health checkup data and health insurance claims data of the Japan Health Insurance Association in Kyoto Prefecture between April 2012 and March 2016. TTM stages of change obtained from questionnaires at the first health checkup and categorized into six groups. The primary outcome was defined as a more than 30% decline in eGFR from the first health checkup. We fitted multivariable Cox proportional-hazards model for time-to-event analyses adjusting for age, sex, eGFR, body mass index, blood pressure, blood sugar, dyslipidemia, uric acid, urinary protein, and existence of kidney diseases at first health checkup.ResultsWe analyzed 239,755 employees and the mean follow-up was 2.9 (standard deviation, 1.2) years. As compared with the stage 1 group, the risk of eGFR decline was significantly low in the stage 3 group (hazard ratio [HR] 0.77; 95% confidence interval [CI], 0.65–0.91); stage 4 group (HR 0.80; 95% CI, 0.65–0.98); and stage 5 group (HR 0.79; 95% CI, 0.66–0.95).ConclusionCompared with the precontemplation stage (stage 1), the preparation, action and maintenance stages (stages 3, 4, and 5), were associated with a lower risk of eGFR decline.

Relationship between salt reduction readiness and salt intake in hypertensive patients: a single nonspecialized hypertension clinic case study.

This is the first report about the association of readiness for salt reduction with daily salt intake or the salt check sheet score in hypertensive patients at a nonspecialized hypertension clinic. We investigated whether salt reduction readiness as evaluated based on the transtheoretical model (TTM) is associated with estimated daily salt intake or the salt check sheet score. The TTM allows evaluators to easily assess a subject's level of readiness for health-related according to five stages. There was no significant relationship between the TTM stages and estimated daily salt intake. A significant correlation was found between the TTM stages and salt check sheet scores (ρ = -0.409; P < 0.001). When providing salt reduction guidance to hypertensive patients, it is effective for healthcare professionals to use repeated urine tests and salt check sheets to take a salt reduction approach according to the level of readiness of the patients.