The Transtheoretical Model Stages Research Articles

Self-efficacy, psychological adjustment and decisional-balance regarding decision making for outpatient chemotherapy in Japanese advanced lung cancer

This study examined the application of the trans-theoretical model (TTM) for readiness for decision-making of outpatient chemotherapy of Japanese advanced lung cancer patients by a cross sectional questionnaire survey. A questionnaire was conducted with 105 Japanese patients diagnosed with advanced lung cancer receiving chemotherapy. We classified them according to the TTM stages, including 4 in precontemplation, 42 in contemplation, 22 in preparation, and 35 in action. The valid model (χ 2 (37) = 42.56, p = 0.24; GFI = 0.93; AGFI = 0.88; CFI = 0.98; RMSEA = 0.04; AIC = 100.56) derived from structural equation modeling (SEM) revealed that stage of outpatient chemotherapy was significantly affected mostly by decisional-balance (β = 0.60, p < 0.001) and partially by time from the patient's house to the hospital (β = −0.15, p < 0.10), and that decisional-balance was significantly affected by self-efficacy (β = 0.48, p < 0.001) and nausea (β = −0.23, p < 0.01). The findings from our study provided encouraging results for adopting the TTM in decision making for outpatient chemotherapy in Japanese cancer care and several clinical implications were obtained from the results.

Cognitive and behavioral predictors in the process of smoking cessation during pregnancy: Testing for discontinuity patterns in the Transtheoretical Model

The aim of the study was to assess predictive power of cognitive variables and health-promoting behaviors for the process of smoking cessation described in terms of the Transtheoretical Model (TTM). Participants in the study were 150 women (mean age 26.93, SD = 4.56 years), in uncomplicated pregnancy. Cigarette smokers constituted 29.3% of the sample, while the rest had previously quitted smoking (in that number 42.1% during pregnancy). Beliefs and expectations were measured by means of scales developed by the author, while health-related behaviors were assessed using the Health Behavior Inventory (HBI) by Z. Juczynski, supplemented with pregnancy-specific behaviors. TTM discontinuity patterns were tested in the study using polynomial-based orthogonal contrasts. Statistically significant linear trends were found for expectations concerning the infant’s health state and the course of delivery, for beliefs about the effect of maternal smoking on infant health, as well as for pregnancy health behaviors. The obtained results were confirmed by hierarchical regression analysis, with smoking cessation explained to a larger extent by cognitive factors than by health-related behaviors. This may suggest that the TTM is a “pseudo-stage” model, and a general change of the variables under study is of greater importance for the process of smoking cessation than focusing on the TTM stages.

Analysis of the willingness for behaviour changes in participants of an inpatient fasting cure using the transtheoretical model

Background The transtheoretical model of change by Prochaska und DiClemente describes individuals moving through a series of stages—precontemplation, contemplation, preparation, action, and maintenance—in the adoption of behaviour changes. The aim of the study is to describe the process of behaviour changes in patients performing a fasting cure over 10 days. The evaluation is performed by using the transtheoretical model and will highlight factors that influence the fasting cure and that can be used to modify the fasting cure. In addition the study investigates which effects fasting cures exert on the willingness to modify the lifestyle and how the effects can be related to other health-related lifestyle modifications. Hypotheses 1. The fasting cure promotes the willingness to modify the lifestyle; the progression is visible in the series of states in the transtheoretical model. 2. Before starting the fasting cure patients show an individually different willingness to modify their health-related lifestyle, i.e. they find themselves in different stages of the transtheoretical model. 3. After the fasting cure patients find themselves on heterogene stages of the transtheoretical model. The model can involve an improvement, a stagnation, or a worsening of the patient's motivation to achieve a sustained effect in modifying the health-related lifestyle. 4. The follow-up, which takes place 4 weeks after finishing the fasting cure, will demonstrate that patients maintain their behaviour change, i.e. there will be no regression in the sense of the transtheoretical model. Methods All patients who entered the fasting cure in the German Clinic for Integrative Medicine (DEKIMED) were interviewed before and after (10th day) the fasting cure regarding their opinion about the fasting cure and their motivation to participate. Four weeks after leaving the clinic patients again were interviewed using a questionnaire. The analysis of the structured interviews was performed between August and October 2008 using a semiquantitative and qualitative analysis method.

Smoking behaviour and attitudes to periodontal health and quit smoking in patients with periodontal disease

The aim of this study was to assess oral health-related beliefs and attitudes, health behaviour of smokers in relation to the Transtheoretical Model (TTM) of behaviour change, willingness to have smoking cessation provided together with periodontal treatment. Postal questionnaire was sent to 500 referred patients. Part 1 looked at attitudes and beliefs about periodontal disease, Part 2 aimed at current smokers focused on the TTM and smoking cessation. Response rate was 56% (n=277); 67% females, 33% males. Mean age was 44.9 years (SD 12.45); 24.5% current smokers, 30.3% past smokers, 45.5% never smokers. Fewer smokers reported "bleeding gums" (p=0.027), but more smokers reported "having loose teeth" (p=0.016). The TTM stages of change indicated that 31% of current smokers were in pre-contemplation of quitting smoking, 46% were in contemplation and 23% were in preparation. Twenty-three percent of the past smokers were in action and 77% in maintenance. Smokers showed differences in the "self-re-evaluation" (p=0.001) and "self-liberation" (p=0.015) processes of change depending on their stage of change (pre-contemplation or preparation). Nearly half (49%) of the current smokers who wanted to quit requested smoking cessation to be provided alongside their periodontal treatment. A large proportion of periodontal patient smokers may be considering quitting, and nearly half requested provision of smoking cessation intervention in conjunction with the periodontal treatment.

Is contemplation a separate stage of change to precontemplation?

Fundamental to a stage-based model of health behavior change is the assumption that there is non-linearity (or discontinuity) in the relationship between predictors and outcomes across stage boundaries. There is, however, little evidence to suggest the stages of the transtheoretical model (TTM) meet this assumption. The aim of this study was to extend previous work on discontinuity in prediction to the TTM stage boundary between precontemplation and contemplation, and to test the homogeneity of the contemplation stage of change. Repeated measures design with telephone surveys conducted two weeks apart. Participants were 708 randomly selected smokers, aged 18-40 years, in the precontemplation and contemplation stages of change. An initial test of the stage boundary between precontemplation and contemplation revealed greater predictive power of a multivariate model in the precontemplation stage. Some evidence of discontinuity in prediction was found within the contemplation stage, between those "open to the possibility" of quitting and those "actually thinking about it." The discontinuity at the TTM boundary was reduced following the exclusion of precontemplators not interested in quitting and when those thinking about quitting within contemplation were also excluded. The stage boundary between precontemplation and contemplation was not strongly supported, and there was weak evidence of a discontinuity within contemplation. The findings question the utility of the current operationalization of the TTM stage boundary.

Computer-Mediated Intervention Tailored on Transtheoretical Model Stages and Processes of Change Increases Fruit and Vegetable Consumption among Urban African-American Adolescents

To examine the efficacy of an intervention based on the transtheoretical model (TTM) for increasing fruit and vegetable consumption among economically disadvantaged African-American adolescents. Pretest-posttest quasi-experimental study. Youth services agencies located in New York, New Jersey, and Pennsylvania. Agencies were assigned to computer intervention (CIN) and nonintervention control study arms. A total of 507 African-American adolescents ages 11 to 14 years. Youths in the CIN arm completed four 30-minute intervention sessions tailored on TTM stages and processes of change. Self-reported fruit and vegetable consumption and stages, pros, cons, and self-efficacy for consumption. Intervention effects were examined with analysis of covariance models that were controlled for demographic variables and baseline measures of each outcome. Chi-square analyses were used to examine between-arm differences in youths' stage progressions. After adjustment by covariates, pros (p < .025) and fruit and vegetable consumption (p < .001) varied significantly with study arm. Youths in the CIN arm had higher pro scores and fruit and vegetable consumption than controls. More youths in the CIN arm than in the control arm progressed to later stages and maintained recommended intake levels (p < .05). A TTM-based intervention can increase fruit and vegetable intake and effect positive changes in TTM variables related to intake among economically disadvantaged African-American adolescents.

The Theory of Planned Behavior Within the Stages of the Transtheoretical Model: Latent Structural Modeling of Stage-Specific Prediction Patterns in Physical Activity

This is the first study to test whether the stages of change of the transtheoretical model are qualitatively different through exploring discontinuity patterns in theory of planned behavior (TPB) variables using latent multigroup structural equation modeling (MSEM) with AMOS. Discontinuity patterns in terms of latent means and prediction patterns for the different stage groups were examined. Adults (n = 3,462) were assessed on their physical activity stages of change and TPB variables. The TPB was separately examined within the five stage groups. The TPB measurement model fit was acceptable. Latent mean analyses with post-hoc contrast and MSEM indicated discontinuity patterns. Results underscore the qualitative differences between the stages that may guide further research and the design of interventions integrating the approaches.

Ethnic Differences in Decisional Balance and Stages of Mammography Adoption

Behavioral theories developed through research with mainstream, English-speaking populations have been applied to ethnically diverse and underserved communities in the effort to eliminate disparities in early breast cancer detection. This study tests the validity of the transtheoretical model (TTM) decisional balance measure and the application of the TTM stages of change in a multiethnic, multilingual sample. A random sample of 1,463 Filipino, Latino, African American, Chinese, and White women aged 40 to 74 completed a phone survey of mammography beliefs and practices. Consistent with the TTM and independent of ethnicity, decisional balance was associated with mammography stage in all five ethnic groups when controlling for socioeconomic and other factors. In addition, having private insurance and a regular physician and being a long-time resident in the United States were positively associated with mammography maintenance. The application of the TTM for mammography is supported in a multiethnic and multilingual sample.

The distribution and predictive validity of the stages of change for mammography adoption among Canadian women

Objective To examine the predictive validity of the transtheoretical model (TTM) stages of change for mammography participation in Canadian women. Method We examined the association between baseline TTM stage of mammography adoption and subsequent mammography participation in a representative sample of 3125 Canadian women aged 40 and older from the longitudinal Canadian National Population Health Survey. Results The likelihood of having a mammogram at follow-up (1998/1999) increased with progressive stages of change at baseline (1996/1997) even after adjusting for potential confounders. Relative to women in maintenance, women in precontemplation, relapse, contemplation, relapse risk, and action were significantly less likely to report a recent mammogram during follow-up (adjusted RR of 0.41, 0.50, 0.63, 0.75, and 0.92, respectively; P trend < 0.01). This pattern held for women within and outside of the 50–69 target age range, and for urban and to a lesser degree rural-dwelling women. Conclusion Our findings support the predictive validity of the TTM stages of mammography adoption construct and the inclusion of both relapse and relapse risk categories to improve the sensitivity of the predictive model. Interventions to promote the eventual maintenance of mammography screening should also benefit from further research that aims to understand the variables that promote progressive movement through the stages.

Applying the Transtheoretical Model to Physical Activity in Family Caregivers in Taiwan

The objective of this study was to examine whether specific constructs from the Transtheoretical Model (TTM)(i.e., stages of change, self-efficacy, and perceived benefits and barriers) relative to regular physical activity are applicable to Taiwanese family caregivers. A descriptive and cross-sectional design was used. A convenience sample included 108 primary family caregivers of mentally ill patients receiving home care from a psychiatric hospital in southern Taiwan. After obtaining institutional review board approval and subject's consent, subjects' demographics, stages of change for regular physical activity, self-efficacy, and perceptions of the benefits of and barriers to regular physical activity were assessed through the questionnaire. Subjects in the later stages of the TTM (action or maintenance) had significantly higher levels of self-efficacy than those in earlier stages (precontemplation or contemplation)(p<0.05). No significant difference was found in the level of perceived benefits and barriers across different TTM stages. This study provides partial support for the hypothesized relationships between constructs derived from the TTM. Since this is the first TTM study in Taiwan, continued TTM testing is needed to adequately determine the applicability of the TTM and to identify the most effective theory-based physical activity interventions.

Evaluation of Software-Based Telephone Counseling to Enhance Medication Persistency Among Patients with Multiple Sclerosis

To evaluate the effect of a software-supported intervention based on the Transtheoretical Model of Change and motivational interviewing on decreasing discontinuation (or increasing persistency) of Avonex (interferon beta-1a--Biogen), a medication for treatment of multiple sclerosis (MS). Randomized controlled experimental design comparison of software-based telephone counseling (intervention group) and standard care (control group). United States. 366 patients with MS. Software-based telephone counseling. Discontinuation of Avonex treatment and movement among stages of the Transtheoretical Model of Change. Patients in the software intervention group demonstrated a statistically significantly lower proportion of Avonex treatment (1.2%) discontinuation than the standard care group (8.7%). In addition, stage movement away from discontinuation of Avonex (i.e., toward continuation of therapy) was significantly higher in the treatment group. The Transtheoretical Model of Change constructs and motivational interviewing processes were effectively incorporated into a software-based intervention program, and this significantly decreased the proportion of patients who discontinued treatment of MS with Avonex. The integration of behavioral theory with information systems offers a promising approach for pharmacists and other providers to promote medication persistency.

Gaining control: trends in the processes of change for video lottery terminal gamblers

This study examined the processes of change used by problem gamblers in the action and maintenance stages of the Transtheoretical Model of Change (TTM) as proposed in the research by Prochaska and DiClemente. A sample of 25 problem gamblers in the action stage and 38 in the maintenance stage were compared in terms of usage of three of these processes (counterconditioning, stimulus control and reinforcement management). Two mediating variables, self-efficacy and situational temptation, were also assessed. As hypothesised, the usage of counterconditioning and stimulus control declined significantly between the action and maintenance stages. No change was found in reinforcement management between the stages. Self-efficacy increased and situational temptation declined between the action and maintenance stages. Problem gamblers made significant use of these processes suggesting the TTM model is applicable to problem gambling. The discussion focuses on possible regulatory and venue operator actions that might help the problem gambler utilise these processes in the natural recovery process.

Obesity and physical activity in college women: implications for clinical practice.

To investigate the relationships between levels of physical activity, health attitudes and behaviors, and specific health indicators in women attending college. A convenience sample of 116 college women, ages 18 to 24 years, participated in this research study at a moderate-sized midwestern university. The data were obtained through a self-administered questionnaire; trained technicians collected physiological measurements. The young women in this study had, on average, normal body mass indexes (BMIs) and reported activity levels consistent with or greater than the Centers for Disease Control and Prevention/American College of Sports Medicine guidelines. Items used to assign participants into the appropriate stage of the transtheoretical model of change were correlated with participants' perceived personal physical activity levels. Similarly, the participants, whose scores fell in the higher stages of the transtheoretical model, reported greater levels of physical activity; consumption of more fruits, vegetables, and water; and less consumption of high-fat/high-calorie foods. The years between ages 18 and 24 are a critical time in the lives of young women. During this period, they develop physical activity and nutrition habits that will affect their health across the life span. Because of the sometimes insidious development of major health problems, young women's current health status may not accurately reflect the possible long- term results of negative health habits. Nurse practitioners (NPs) have many opportunities to identify and address major factors that, if unattended, may threaten the life-long health status of women. Health teaching in the areas of physical activity and dietary habits may be useful even in young women who appear to be healthy, are of normal weight, and are physically active. Poor dietary habits, if unattended, may eventually contribute to the development of obesity and related illnesses.

Review: stage based interventions did not influence smoking behaviour

Riemsma RP, Pattenden J, Bridle C, et al . Systematic review of the effectiveness of stage based interventions to promote smoking cessation. BMJ 2003;326:1175–7.[OpenUrl][1][Abstract/FREE Full Text][2] Q Do stage based...

EXERCISE ADHERENCE IN OLDER ADULTS

Older adults are not meeting the Surgeon General's recommendations for daily physical activity. Some success has been reported in interventions that utilize the Transtheoretical Model (TTM) for behavior change by tailoring health education according to the various TTM stages. This intervention has not been thoroughly examined in older adults. PURPOSE To increase physical activity adherence (PAA), and improve the physical performance and perceived physical and emotional health (PPEH) of sedentary, older adults utilizing a TTM stage-based physical activity education program. METHODS Twenty-three sedentary, older adults in a Pre-Action stage of the TTM were assigned to either a behavior modification (BM) (76 years ± 7) group or an education awareness (EA) (62 years ± 7) group. Both groups were given the same progressive, home-based, 12-week physical activity program. All received at least 3 classes before the study to learn how to perform the exercises correctly and safely. The BM group participated in a 12-week structured, TTM-based education program. The EA group received general information about exercise at the start of the program. To measure PAA, participants were given exercise logs to complete and return weekly. TTM, physical performance (strength, balance, cardiovascular, and flexibility), and the PPEH (using the SF 36) were measured pre-and post-intervention. RESULTS Movement through the TTM was the same for both groups (pre-intervention, 100% of both groups were in Pre-Action; at Week 12, 30% remained in Pre-Action while 70% moved to Action). The BM group had greater PAA over the 12 weeks than the EA group. Both groups had significant improvements in upper body strength measured in timed arm curl repetitions (p < .05), cardiovascular endurance measured via the 2 Minute Step Test (p < .05), and in PPEH (p < .05). CONCLUSION Older adults can adhere to a structured, home-based physical activity program. Behavior modification, organized by the TTM, was an effective strategy to increase PAA in older adults. Supported by the University of CT Gerontology Fellowship.

Exploring discontinuity patterns in the transtheoretical model: An application of the theory of planned behaviour.

OBJECTIVES: The principal objective of the present paper was to investigate the utility of an extended theory of planned behaviour (TPB) for discriminating between stages of the transtheoretical model (TTM). DESIGN: Congruent with Sutton (2000) a cross-sectional design was employed. The study (N = 331) investigated the TPB and TTM in the domain of health-related food choice. METHOD: The study utilized a questionnaire methodology. The data were analysed using analyses of variance and polynomial contrast analyses. RESULTS: Results showed a significant linear trend for all TPB variables across TTM stages, although there were significant quadratic relationships between TTM stage and both subjective norm and behavioural intention. Hierarchical regression analyses indicated that TTM stage might best be regarded as a proxy measure of behaviour. CONCLUSIONS: The present study provides evidence to support the utility of the TPB but casts doubt on the TTM. Further research is required to evaluate the effectiveness of interventions targeted at individuals in certain stages with variables informed by the TPB, and to extend the present findings beyond the domain of health-related food choice.

Exercise and the Transtheoretical Model: A Longitudinal Test of a Population Sample

Background. The purpose of this study was to test the ability of the Transtheoretical Model (TTM) to predict exercise stage transition of individuals in a large, untreated-population-based, random sample of Canadian adults (18–65 years of age) over two consecutive time periods.Methods. Assessments of TTM's stage of exercise behavior change, self-efficacy, pros, cons, experiential processes, and behavioral processes were made at baseline (time 1), 6 months (time 2), and 1 year (time 3). Six hundred eighty-three men and women, identified through random-digit telephone dialing, completed all measures across the three time points. Within each time period (time 1–2; time 2–3) participants were categorized as having regressed (moved back at least on stage), remained (no stage change), or progressed (moved forward at least one stage). Baseline TTM constructs were analyzed for their ability to predict change transition across the two time periods.Results. Of 40 possible predictions (20 for each time period) 18 (45%) were supported.Conclusions. Overall, the findings demonstrate partial support for the internal validation of TTM in the exercise domain. Implications of the findings are discussed and future directions for researchers, practitioners, and program planners are provided.

THE EFFECTIVENESS OF PERSONAL TRAINING ON CHANGING ATTITUDES TOWARDS PHYSICAL ACTIVITY

More and more people seeking the expertise of personal trainers in recent years. With very few previous efforts evaluating the effectiveness of the personal training experience in the scientific literature, this study utilized movement in the Stages of the Transtheoretical Model (STM) to determine the efficacy of personal training. One hundred twenty nine volunteer participants (clients) (age range: 20 65 years old) were assigned a university senior personal trainer for a10-week program. At an initial meeting, the clients were given a form to self-assess their stage of motivational readiness for exercise adoption (STM) choosing one of five stages: Pre-contemplation (not intending to make changes), Contemplation (considering a change), Preparation (getting ready to make a change), Action (actively engaged in making a change but only for a short while) & Maintenance (sustaining the change over time). After the initial assessment, the clients and trainer then met once a week and had targeted discussions on problem solving techniques such as determining the Benefits of Physical Activity, Barriers/Obstacles to Exercise, Support System Recruitment, Goal Setting and Relapse Prevention in addition to providing specific suggestions for the client's other exercise days during the week. At the end of the 10-week personal training program, the clients then reassessed their stage of motivational readiness for exercise adoption. Of the 129 clients tested, 27 were in the maintenance (highest) stage and therefore could not move up. None of these 27 clients moved down a stage. Of the remaining 102 clients, there was significant (p < 0.01) upward movement at the conclusion of the program. 61 clients (60%) moved up one stage, 13 clients (13%) moved up two stages, 27 clients stayed at the same stage (26%) and one (1%) moved down a stage. The results suggest that one-on-one personal training is an effective method for changing attitudes and thereby increasing the amount of physical activity. Secondly, it seems that using problem-solving techniques is of value for successful behavior change.