We explored the effects of continuation care based on trans-theoretical model (TTM) in adult patients with acute leukemia (AL). Patients with AL who had been discharged from our hospital were randomly assigned to the control group (n = 68) and intervention group (n = 74). The control group received routine nursing, while the intervention group received a structured psychoeducational follow-up program based on the Transtheoretical Model (TTM). 2 months after intervention, the quality of life (QoL), mood, self-care ability, and incidence of complications were assessed and compared. The patients were then followed up for 18 months to observe their long-term survival. The incidence of complications was significantly lower in the intervention group than in the control group, whereas the QoL scores, positive mood scores, and self-nursing ability scores were higher (P<0.05). At a median follow-up of 18 months, the overall survival was significantly better in the intervention group than in the control group (P = 0.013). The Program effectively reduced the incidence of complications and improved the QoL, emotional well-being, and self-nursing ability, thereby offering certain advantages in enhancing the AL patients' survival rates. The TTM-based continuation care can be implemented to improve the QoL in patients with AL, and is worth promoting.

This study explores the process of adopting and maintaining breast self-examination (BSE), a key method for early breast cancer detection in women, using the Transtheoretical Model (TTM) as a theoretical framework. Conducted between February and April 2021 via digital platforms, the study recruited participants through WhatsApp, Instagram, and e-mail. Custom-designed TTM-based scales targeting BSE behavior were administered. Data were analyzed using IBM SPSS 22 and AMOS 22. Validity analyses included content, criterion, and construct validity, employing both exploratory and confirmatory factor analyses. Reliability was assessed through Cronbach's alpha, split-half method, Hotelling's T², item-total correlations, intra-class correlation coefficients, and standard error calculations. The results demonstrated that the developed scales are valid and reliable tools for measuring behavioral change related to BSE. This study underscores the utility of the Transtheoretical Model in understanding women's health behavior and provides a solid basis for future BSE-focused health education and intervention programs.

Adherence to and perceptions of a Peruvian osteoarthritis clinical practice guideline among physiatrists and residents.

This study examined hospital preparedness and radiation risk perception among nurses in Iran, uniquely applying the Transtheoretical Model to identify behavioral predictors of emergency readiness. This cross-sectional study was conducted among 152 health care workers in three teaching hospitals. Four validated tools assessed hospital preparedness, knowledge, risk perception, and stages of change. Linear regression identified predictors of behavioral progression. While the hospital equipment domain scored highest (mean 18.3/21), the education domain scored lowest (mean 2.3/4). Notably, 85.5% of nurses remained in the passive stages of change, with only moderate levels of risk perception. Cognitive (β = 0.937) and behavioral processes (β = 0.763) strongly predicted stage advancement, extending previous findings on behavioral determinants of disaster preparedness. This study suggests that psychological readiness may play an important role in radiation emergency preparedness. Stimulus control and reinforcement management represent critical behavioral targets that are often overlooked in traditional training. Policymakers should consider shifting from awareness-only approaches to stage-matched, behaviorally driven interventions that address nurses' emotional barriers and support sustained readiness.

From fragmentation to transtheoretical models of psychological therapy.

The WHO European Region has among the lowest rates of exclusive breastfeeding (EBF), with substantial variability across countries. In Italy, EBF rates remain below WHO targets, particularly in Southern regions. Several tools have been proposed to assess mothers' attitudes toward breastfeeding, although no gold standard has been established. This study aimed to explore mothers' attitudes toward breastfeeding using a questionnaire based on the Trans-Theoretical Model (TTM). An observational study was conducted in two Sicilian hospitals, where mothers were enrolled during postpartum hospitalization and interviewed using a structured questionnaire. The most frequently observed stage of change was action (39%, n = 123/318), followed by contemplation (22%, n = 70/318), pre-contemplation (21%, n = 67/318), and determination (18%, n = 58/318). A significant trend was observed across stages of change in relation to infant feeding patterns during hospitalization (p < 0.0001), with higher stages showing a greater proportion of exclusive breastfeeding. The TTM-based approach may provide preliminary insights into mothers' attitudes toward breastfeeding, particularly in the pre-contemplation and contemplation stages of change. However, given the exploratory design, further studies are needed to refine the questionnaire and to assess its performance in longitudinal settings.

Few children achieve the recommended daily levels of physical activity. Active school transportation (AST) offers a valuable opportunity to increase children's physical activity. Initiatives promoting AST in early childhood are important and have the potential to reverse the decline in physical activity. This study protocol outlines an age-cohort design to evaluate the effectiveness of the Sustainable Innovation for Children Transporting Actively (SICTA) intervention on children's AST. SICTA is a 4-week school-based intervention that incorporates gamification elements to enhance motivation and aims to increase AST in children. The intervention involves children and their parents as gatekeepers, as well as teachers delivering the intervention. All children, parents, and teachers in all schools, from grades 4 to 6 in one municipality in the southern part of Sweden, will be invited to participate in the evaluation. Following the age-cohort design, students at baseline (late fall 2024) will be compared with students of the same age from the same schools 1 year later at follow-up (late fall 2025) after receiving the intervention (implemented in late fall 2025). Using questionnaires at baseline and follow-up, this study will examine the effects of the intervention on children's levels of AST. Children's independent mobility and several mediators related to AST in both children and parents, based on the theory of planned behavior, the transtheoretical model of change, and self-determination theory, will also be examined. The intervention will also be evaluated from a sustainable perspective using the sustainable value equation. At follow-up, data collection will include a questionnaire for teachers assessing the feasibility of the intervention. The project is funded for the period 2024-2026, and follow-up data collection is ongoing following completion of the intervention in late fall 2025. Results will be reported according to the predefined outcomes, including changes in AST, children's independent mobility, psychosocial determinants among children and parents, and sustainability outcomes, as well as feasibility. The findings are expected to provide valuable insights into the effectiveness of the SICTA intervention, facilitating knowledge dissemination among end users and policymakers. Swedish National Research Database Researchweb.org 283668; https://tinyurl.com/496rc6r4. DERR1-10.2196/92946.

Background/Objectives: To promote salt reduction before health problems arise, it is important to understand factors associated with reduced-salt product purchasing among consumers with low interest in such products. This study examined psychological determinants of intention to purchase reduced-salt products among Japanese adults who were not actively purchasing them. Methods: An exploratory sequential mixed-methods design was used, including qualitative interviews followed by a cross-sectional web-based survey of 800 men and women aged 18–59 years in Japan. Participants were categorized into precontemplation and contemplation stages based on the transtheoretical model. Associations between purchase intention and three Integrated Behavioral Model categories—attitude, perceived norm, and personal agency—were examined. Percentage-to-gain values were calculated for each belief item. Results: All three category scores were significantly associated with purchase intention, with attitude showing the strongest association (OR = 12.56, 95% CI: 6.93–22.79). In stratified analysis, attitude showed a stronger association in the precontemplation stage (OR = 18.40, 95% CI: 8.51–39.78), whereas no category score was significantly associated with purchase intention in the contemplation stage. In the precontemplation stage, relatively high percentage-to-gain values were observed for holistic wellness-oriented beliefs and product availability in usual supermarkets. Conclusions: Attitude was most strongly associated with intention to purchase reduced-salt products, particularly in the precontemplation stage. Holistic wellness-oriented beliefs and product availability may represent promising targets for future communication or food environment interventions. These findings may provide a basis for future studies testing strategies to increase actual purchases of reduced-salt products and reduce salt intake.

A research project should include the use of a well-chosen theory, model, or framework. However, this is often missing in published research. The critical importance of incorporating theory, models, and frameworks into pharmacy practice research to enhance the rigor, relevance, and generalizability of study findings is highlighted in this paper. Beginning by defining what constitutes a theory, model, or framework, and then discussing their pivotal role in guiding research design, methodology, data interpretation, and the development of interventions, this paper addresses not only the importance of using them but also outlines practical considerations for identifying and integrating them at various stages of the research process within pharmacy practice. An overview of several widely used theories, models, and frameworks relevant to this field is provided, including the Theory of Planned Behavior, the Health Belief Model, the Consolidated Framework for Implementation Research, the Andersen Behavioral Model of Health Services Use, the Donabedian Model, and the Transtheoretical Model of Behavior Change. For each of these, clear explanations are offered, and their unique contributions to advancing the discipline are discussed. Furthermore, concrete examples demonstrating how these theories, models, and frameworks have been applied in pharmacy practice or pharmacy-related research are presented, illustrating their value in addressing diverse research questions and promoting evidence-based practice. Through this review, we aim to empower researchers and practitioners on how to thoughtfully select and apply theories, models, and frameworks, thereby ultimately advancing the science and practice of pharmacy.

Hispanic/Latinx populations in the U.S. experience higher rates of chronic disease linked to physical inactivity, yet digital health interventions remain largely inaccessible to more than 16 million Hispanic/Latinx adults with limited English proficiency. While large language models (LLMs) offer scalable personalization, their use in non-English behavioral coaching is unexplored. This study introduces MHC-Coach-ES, a Spanish-language LLM fine-tuned on the Transtheoretical Model (TTM) of behavior change. We fine-tuned Llama 3-70B-Instruct using a two-stage pipeline. First, the model was adapted to Spanish health and motivational language using a 2.21-million-token corpus. Second, it was instruction-tuned on 3,268 translated human written messages to align the model with the Transtheoretical Model (TTM) of Behavioral Change. We compared MHC-Coach-ES with Llama 3-70B-Instruct and translated human-expert messages using a forced-choice preference survey (N = 77) and blinded expert review (N = 2). Spanish-speaking participants significantly preferred MHC-Coach-ES messages over translated human-expert messages (81% preference, P <0.001). Linguistic analysis showed that MHC-Coach-ES produced more temporally anchored messages than the base model (65% vs. 20%), while maintaining readability. In blinded evaluation, clinical experts rated MHC-Coach-ES higher for alignment with Transtheoretical Model stages than human-expert messages (4.83 vs. 4.38 out of 5). The base model also outperformed translated expert messages across preference and expert ratings. Generative AI can operationalize behavioral science frameworks in Spanish, offering a scalable approach to reducing health disparities. The strong performance of both MHC-Coach-ES and the base model highlights the promise of generative and personalized approaches over translation-based localization for theory-driven behavioral interventions.

The Voice Eruption Volcano Model: A Conceptual Framework for Understanding and Preventing Voice Problems among School Teachers.

Application of the Transtheoretical Model of Behavior Change Framework to Evaluate Readiness and Barriers to Voice Therapy Among School Teachers.

The transtheoretical model and smoking cessation: findings from a youth-friendly clinic.

Introduction Consolidating the achievements of the Sloping Land Conversion Program (SLCP) is key to future sustainable operation and the promotion of comprehensive rural revitalization of the SLCP. Methods On the basis of the transtheoretical model and stages of change (TTM) and using the fuzzy-set qualitative comparative analysis (fsQCA) model, this study examined the realization paths of the consolidation of the SLCP in Guizhou Province from the perspectives of value perception and government regulation. Results First, the differences in value perception and government regulation determine the different states of SLCP consolidation, and strong value perception and effective government regulation are the key conditions for effectively consolidating the SLCP and achieving economic development and ecological protection. Second, three different paths can support farmers’ transformation from willingness to engage in behavior, and two different paths can support farmers’ transformation from behavior to continued behavior. Value perception and government regulations have formed a diversified configuration for farmers to maintain the SLCP in a “multi-concurrent” manner. Third, on the basis of the corresponding cases covered by the configuration paths, this paper proposes three paths for consolidating the SLCP, namely, consolidating the SLCP under the conditions of implicit risk status, intermittent status, and high-risk status. Discussion The conclusions obtained will propose more targeted and operational paths for the SLCP maintenance behavior of farmers and long-term consolidation mechanism of the SLCP.

BackgroundZinc oxide (ZnO) added to pig feed at prophylactic levels has been used to reduce post-weaning diarrhoea (PWD) and enhance performance. In response to concerns about antimicrobial resistance (AMR) and environmental contamination, supplementation with ZnO was prohibited in the European Union from June 2022, and in the United Kingdom from June 2024.Objective and methodWe investigated the impacts of the withdrawal of ZnO on the health and welfare of weaned pigs as perceived by pig producers, and the management and husbandry factors associated with PWD in the United Kingdom. A mixed methods approach combined qualitative interviews with producers preparing to withdraw ZnO from their herds and a quantitative survey open to any producer. Findings were integrated using the transtheoretical model (TTM) of change as a guiding framework.ResultsEight qualitative interviews and 14 quantitative surveys with producers were completed. Responses to the qualitative interviews were all from indoor, breeder-finisher herds while the quantitative survey included indoor and outdoor production systems and a mix of breeder-finisher herds and nursery units. In the qualitative interviews, producers described ZnO as affordable and effective. Concerns were expressed that its withdrawal risked triggering a sectoral increase in antimicrobial usage, jeopardising reductions achieved to date. The quantitative survey revealed that almost all respondents (12/14, 85%) had experienced PWD in their piglets in the last year. At the time of responding, 57% of respondents (8/14) reported weaner pigs were not fed a diet containing ZnO during the post-weaning period whereas 36% (5/14) were still feeding a diet containing ZnO. Following the withdrawal of ZnO in June 2024, most respondents (8/14, 57%) anticipated supplementing weaner diets with an alternative to ZnO before and after weaning.ConclusionWhile recognising the limitations of a small sample size, the study contributes to our understanding of producer perceptions as they prepared for the withdrawal of ZnO. Producer concerns that PWD would be less effectively controlled in their herds and risked triggering an increase in antimicrobial usage were highlighted. Further work is required to better understand the type and effectiveness of alternatives to ZnO on pig health and welfare.

Human–AI coevolution is characterized by a fundamental tension between comfort – predictable, low-effort interaction that supports trust – and growth – the introduction of challenge that enables learning and development. AI systems that over-optimize for comfort risk reinforcing cognitive inertia, while systems that introduce excessive challenge may erode trust and user agency. Drawing on psychological theories including Vygotsky's Zone of Proximal Development, Kahneman's dual-process theory, and the Transtheoretical Model of Change, we propose a dual-mode framework that conceptually delineates how AI systems can transition between predictability mode (consolidating trust, reducing cognitive effort) and growth mode (introducing calibrated challenges). Rather than resolving the comfort-growth tension, effective human-AI thought partnership depends on managing it through principled mode switching within a stable interactional meta-framework. We clarify the conceptual scope of this proposal, situate it primarily within related work on human-AI educational, training, and skill development contexts, and briefly discuss ethical and agency implications. The framework, which extends to other forms of AI-mediated exploratory interaction—information retrieval, media consumption, marketplace navigation, conversational agents—is intended as a design-oriented, non-operational contribution to research on human-centered AI and long-term human-AI development.

IntroductionTobacco use significantly contributes to the occurrence of morbidity and mortality. Therefore, preventing tobacco use is very important to reduce these health risks. Groups that have jobs (such as bus drivers) have increased susceptibility to tobacco use based on extended work hours, workplace-related stress, sedentary job activities, and social peer pressure, all of which can increase the likelihood of tobacco use. Tobacco education programs that are located at the workplace provide a good opportunity for educating workers about smoking cessation and increasing their knowledge, motivation, and readiness to stop using tobacco.AimThis study aims to determine whether cognitive behavioral therapy (CBT)-based tobacco education programs or basic health education (BHE) tobacco education programs are effective for increasing quit readiness among bus drivers.MethodsA randomized comparative pilot trial compared CBT and BHE interventions on quit readiness among 40 active male smoker bus drivers. Participants were randomized into a CBT-based tobacco awareness program (n = 20) or a BHE-based program (n = 20). The transtheoretical model (TTM) stages of change were assessed at baseline, four weeks, and six months using the validated stages of change questionnaire.ResultsBaseline stage distributions were comparable (p = 0.751). At four weeks, the CBT group showed significantly greater progression toward the preparation and action stages (p = 0.033). At six months, the CBT group demonstrated substantially greater advancement toward the action and maintenance stages (p = 0.001).ConclusionWorkplace-based tobacco awareness programs incorporating CBT were more effective than BHE in enhancing quit readiness, as measured by TTM stage progression, among bus drivers. These findings should be interpreted with caution, given the pilot design, reliance on self-reported outcomes, and the absence of biochemical verification of cessation. Larger, multicenter trials with longer follow-up and objective cessation measures are needed to confirm these results.

ABSTRACT With the widespread adoption of smart devices, mobile health applications (mHealth) have become important tools for elderly health management. However, their long-term effects remain underexplored. This study examines the long-term impact of different mHealth application types on elderly health behaviors, integrating the Health Belief Model (HBM) and Transtheoretical Model (TTM) to construct an assessment framework. Data from 1,500 older adults were analyzed using a random forest model which achieved an accuracy of 0.842[0.816, 0.868] and an area under the curve (AUC) of 0.803,[0.776, 0.830],demonstrating robust predictive performance. Results show that self-efficacy and perceived health risks significantly influence the long-term maintenance of health behaviors. Additionally, different mHealth applications have varying effects, with virtual health assistants and wearable devices being more effective than voice assistants. These findings offer practical guidance for designing mHealth interventions tailored to promoting sustained health behavior change among older adults.

Smoking tobacco is a critical modifiable risk factor for periodontal and peri-implant diseases. This narrative review integrates established behavioral theories with communication-based psychological processes to propose an evidence-based model for smoking cessation support in periodontal care. While the model is developed around smoking cessation, its underlying principles are applicable to broader behavioral risk factor management in dental practice. Evidence from systematic reviews, randomized controlled trials, and international guidelines was synthesized to determine effective strategies. Key concepts analyzed include the transtheoretical model (TTM), the COM-B model and motivational interviewing (MI), and the impact of personalized risk communication and biofeedback on patient adherence. Structured behavioral interventions, particularly in combination with pharmacotherapy and personalized feedback (e.g., risk scores or biomarker testing), improve quit rates and, consequently, periodontal outcomes. The proposed four-stage behavioral support staircase provides a clinical support structure comprising connection (rapport), information, motivation and action, with continuous evaluation. Complementing this is an "elemental" metaphor to guide clinicians through patient resistance, ambivalence, and the emotional adaptation inherent in cessation. Smoking cessation serves as a model for how structured behavioral support can be integrated into periodontal therapy. The presented frameworks provide oral health professionals with guidance on the complex cognitive, emotional, and motivational transitions necessary for achieving long-term periodontal stability. This educational model enables periodontal teams to systematically address modifiable behavioral risk factors. It offers a four-stage approach to supporting cessation and managing relapse, shifting the focus from didactic instruction to a patient-centered collaborative approach.

ABSTRACTObjective:To evaluate the potential impact of family-centered care combined with the transtheoretical model on the health behaviors of children with nephrotic syndrome.Methodology:A retrospective analysis was conducted on the clinical data of 150 children with nephrotic syndrome admitted to the Department of Nephrology and Immunology of Hebei Children’s Hospital from June 2022 to June 2025. Based on the different nursing intervention protocols, the children were divided into two groups: 73 children who received routine nursing care were assigned to the control group, and 77 children who received family-centered care combined with the transtheoretical model intervention were assigned to the study group. The health behavior compliance rates, clinical outcome measures, complications, and family members’ nursing satisfaction were statistically compared between the two groups.Results:The health behavior compliance rate of the study group (94.81%) was significantly higher than that of the control group (83.56%) (P<0.05). After intervention, the 24-hour urinary protein levels and total cholesterol levels decreased in both groups compared with before intervention, while serum albumin levels increased, with the study group showing better outcomes than the control group (P<0.05). The incidence of complications in the study group (6.49%) was lower than that in the control group (17.81%) (P<0.05). The nursing satisfaction of the children’s family members in the study group (94.81%) was higher than that in the control group (82.19%) (P<0.05).Conclusion:The implementation of family-centered care, combined with the transtheoretical model, in the nursing of children with nephrotic syndrome was associated with significant improvements in health behaviors and compliance rates, potentially optimizing disease control and contributing to a lower risk of complications, and enhancing the satisfaction of children’s family members with nursing.