Showing papers on "Transtheoretical model published in 1997"

The Transtheoretical Model of Health Behavior Change

Abstract: The transtheoretical model posits that health behavior change involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Ten processes of change have been identified for producing progress along with decisional balance, self-efficacy, and temptations. Basic research has generated a rule of thumb for at-risk populations: 40% in precontemplation, 40% in contemplation, and 20% in preparation. Across 12 health behaviors, consistent patterns have been found between the pros and cons of changing and the stages of change. Applied research has demonstrated dramatic improvements in recruitment, retention, and progress using stage-matched interventions and proactive recruitment procedures. The most promising outcomes to date have been found with computer-based individualized and interactive interventions. The most promising enhancement to the computer-based programs are personalized counselors. One of the most striking results to date for stag...

What makes a good staging algorithm: examples from regular exercise.

Abstract: Purpose. This study retrospectively compared subjects from three unrelated studies using eight algorithms to stage exercise behavior. Subjects and settings. Study One included 936 employees involved in a smoking cessation study at four worksites—a medical center, retail store, manufacturing firm, and a government agency. Study Two included 19,212 members of a New England HMO; and Study Three included a convenience sample of 327 adult New Englanders. Measures. The eight algorithms used different descriptions of stages based on the transtheoretical model, as well as different definitions of exercise and response formats. Results. Algorithms using longer, more precise definitions of exercise resulted in larger numbers of subjects being staged in precontemplation and contemplation in comparison to algorithms using shorter definitions, which tended to stage subjects in preparation and action. Maintenance was the most and preparation the least consistently described stage across algorithms. Conclusions. Alterat...

Readiness to adopt a self-management approach to chronic pain: the Pain Stages of Change Questionnaire (PSOCQ)

Abstract: This manuscript describes the development and initial validation of a self-report questionnaire designed to assess an individual's readiness to adopt a self-management approach to their chronic pain condition. Theory and preliminary empirical work informed the development of a pool of items that were administered to a sample of individuals reporting chronic pain. Analyses of the data support a four factor measure that is consistent with the transtheoretical model of change and associated stages of change model. Each of the four factors, precontemplation, contemplation, action, and maintenance, was found to be internally consistent and stable over time. There was also substantial support for each factor's discriminant and criterion-related validity.

Working Toward Freedom from Violence The Process of Change in Battered Women

Abstract: This article explores the utility of applying the Transtheoretical Model of behavior change to the problems facing battered women with a goal of understanding and systematically measuring how battered women work to overcome the abuse in their lives. The central constructs of the Transtheoretical Model—stages of change, processes of change, decisional balance, self-efficacy—are described with supporting research, and the relevance of this model for the issues with which battered women deal is discussed. An awareness of the process and stages of change may be useful for members of the criminal justice system and the helping professions in their dealings with victims of abuse.

Construct validity of stages of change for exercise behavior.

Abstract: Purpose. Previous research examining the transtheoretical model of behavior change within the exercise domain has been limited by use of self-report measures exclusively and inconsistent practices with regard to stage of exercise assessment. The present study was designed to partially circumvent these limitations and extend the current literature by determining the degree of association among stage of exercise and body mass index, cardiorespiratory fitness, exercise behavior, relapse, barriers, and self-efficacy, after controlling for several potential confounders. Design. A descriptive, cross-sectional study. Subjects. Two hundred thirty-five adults (M age = 34.7 years) volunteered to participate. Measures. Participants were classified by stage of exercise and compared on two behavioral, two biometrical, and three psychological variables while statistically controlling for social desirability and demographic differences. Results. Significant between-stage differences were found for the overall set of dep...

Decision-making about genetic testing among women at familial risk for breast cancer.

Abstract: Objective Recent identification of the breast-ovarian cancer susceptibility gene BRCA1 and the breast cancer susceptibility gene BRCA2 have raised the possibility of clinical genetic testing for breast cancer susceptibility. This study examined decision-making about future susceptibility testing among women at familial risk for breast cancer. Based on the transtheoretical model, it was hypothesized that readiness to undergo testing would be related to the ratio between the perceived advantages (pros) and disadvantages (cons) of learning one's susceptibility status. Methods Seventy-four women with one or more first-degree relatives with breast cancer were recruited before a routine mammogram. Participants completed measures assessing readiness to undergo testing, perceived pros and cons of testing, and perceived breast cancer risk. Family history data was used to calculate empiric genetic risk of developing breast cancer. Results Forty-six per cent of participants planned to seek genetic testing as soon as possible, 35% planned to seek testing in the future, and 19% did not plan to seek testing. As expected, greater readiness to undergo testing was associated with a positive decisional balance (pros > cons). Older age and greater perceived risk (but not empiric risk) also were associated with greater readiness. Conclusion The readiness of many women to seek breast cancer susceptibility testing can be attributed, in large part, to their perceptions that the advantages outweigh the disadvantages. Examination of these perceptions suggests that notification of carrier status may have significant effects on women's psychological well-being and breast cancer surveillance and prevention behaviors.

A Practical Guide to the Use of Motivational Interviewing in Anorexia Nervosa

Abstract: The aim of this clinical report is to introduce the concept of motivational interviewing and the psychology of change into the context of anorexia nervosa. We outline the transtheoretical model of change and consider its relevance to anorexia nervosa. We chart the development of brief interventions using concepts from this model and from psychotherapy practice. Finally we illustrate the use of motivational enhancement therapy for anorexia nervosa. © 1997 John Wiley & Sons, Ltd and Eating Disorders Association.

Confirmatory analysis of opinions regarding the pros and cons of mammography.

Abstract: This investigation extends prior research to apply decision-making constructs from the transtheoretical model (TTM) of behavior change to mammography screening. Study subjects were 8,914 women ages 50-80, recruited from 40 primarily rural communities in Washington State. Structural equation modeling showed that favorable and unfavorable opinions about mammography (i.e., pros and cons) fit the observed data. Analysis of variance supported the associations between readiness to obtain screening (i.e., stage of adoption) and opinions about mammography (i.e., decisional balance) previously found in research using smaller samples from another geographic region. This report extends these earlier studies by using structural equation modeling, opinion scales based both on principal component analyses and on a priori definitions, a developmental sample and a confirmatory sample, and by sampling from a different geographic region. It is recommended that future research examine whether opinions regarding the cons of mammography are more individually specific than the pros.

Stages of Change, Decisional Balance, and Self-Efficacy across Four Health Behaviors in a Worksite Environment:

Abstract: Purpose. This study examined differences in decisional balance and self-efficacy scores across the five stages of change and across four health behaviors (exercise, protection from sun exposure, smoking, and dietary fat consumption), and explored the relationship between the frequency of subjects at each stage across four health behaviors. Design. Data for this study were collected as part of a health behavior survey of employees. Setting. The study was conducted in a municipal government worksite in Arizona. Subjects. A total of 393 employees completed the survey. The sample was predominantly white (84.9%) and male (64.4%), with an average age of 42.2 years and a median annual household income of between $40,000 and $59,999. Measures. Previously validated questions to measure stages of change, decisional balance, and self-efficacy were administered, along with questions about demographic variables. Results. Significant differences were found for decisional balance and self-efficacy scores across the five...

Predictors of exercise adherence following participation in a cardiac rehabilitation program.

Abstract: Patients who participate in cardiac rehabilitation programs (CRP) experience significant improvements in quality of life, rehospitalization rates, and mortality associated with cardiovascular disease. The potential efficacy of CRP is limited however, by significant program dropout rates and poor patient adherence to prescribed exercise regimens following rehabilitation. Recently, models of motivational readiness for behavior change, such as the Transtheoretical Model, have been applied to understanding the process of exercise adoption and maintenance. Interventions based on this dynamic model of behavior change have produced significant improvement in adherence to exercise in community and worksite populations. This study investigates the applicability of this model to this special population. Sixty-two men and women completed measures of motivational readiness, self-efficacy, and decisional balance for exercise adoption upon entry into a 12-week cardiac rehabilitation program at posttreatment and at a 3-month follow-up. Patients made signi ficant gains during CRP in time spent exercising and self-efficacy, but not in utilization of the cognitive processes or in the perceived benefits of exercising. Exercise maintenance at follow-up was differentially associated with self-efficacy, decisional balance, and use of behavioral processes at posttreatment. Motivation-based models of exercise adoption may provide insights regarding the adoption and maintenance of regular physical activity in cardiac rehabilitation populations.

Condom use adoption and continuation: a transtheoretical approach

Abstract: Even though using latex condoms can reduce an individuals risk of contracting and transmitting sexually transmitted diseases (STDs) most programs to motivate such use have demonstrated little effect upon overall condom use. Many traditional behavioral change programs are limited by the manner in which they are based upon an action paradigm which implicitly or explicitly views behavior change as a discrete and dramatic movement such as going from never using condoms to always using them. The Transtheoretical Model of Change (TMC) offers an alternative framework for understanding condom use behavior a stage paradigm in which behavior change is seen as an incremental process through a series of stages. This paper summarizes how measures and models of condom use based upon the TMC have been developed and continue to be refined presents preliminary findings with diverse populations and describes intervention applications of a stage paradigm approach to condom use adoption and continuation.

Pharmacists' Readiness for Rendering Pharmaceutical Care

Abstract: Objective: During the 1970s and 1980s, Prochaska and DiClemente developed the Transtheoretical Model (TIM) of Change to explain, predict, and change multiple human behaviors. This study applied the TIM to measure pharmacists' readiness for rendering pharmaceutical care. It also identified and measured factors that facilitate rendering pharmaceutical care and factors that are barriers, as well as the strength of these factors for each stage of readiness. Design: Data were collected using an instrument developed following the work of Prochaska. Pharmacists completed this survey at the 1996 APhA Annual Meeting & Exposition. Results: The results support the theory behind the TIM; that is, with any behavior change, individuals will fall into several stages of readiness for change, and the vast majority will not be ready to take action within the next six months. Also consistent with the theory, the cons of engaging in a behavior tended to be more salient for individuals in the precontemplation/contemplation stages than for those in the action/maintenance stages. Individuals in administrative positions are more likely to engage in behavior that leads to submitting documentation for compensation. Conclusion: Continuing education efforts must address the needs identified in each stage of readiness. Acknowledgments : This study was funded through a grant by the American Pharmaceutical Association and the National Wholesale Druggists Association as part of the Concept Pharmacy Project.

Impact of a longitudinal community HIV intervention targeting injecting drug users' stage of change for condom and bleach use.

Abstract: Purpose. To evaluate the impact of the Long Beach AIDS Community Demonstration Project, a community-based HIV-prevention intervention incorporating principles from the Transtheoretical model in its design and evaluation. Design. Repeated cross-sectional sampling with matched intervention and comparison communities. Setting. Neighborhoods in Long Beach, California, having a high prevalence of drug abuse and prostitution. Subjects. 3081 injecting drug users who were sexually active and/or shared injection equipment. Intervention. Trained peer volunteers distributed fliers featuring role model stories targeted to the population's stage of change. Fliers were packaged with bleaching kits and/or condoms. Measures. Primary outcome measures were exposure to the intervention, condom carrying, and stage of change for disinfecting injection equipment with bleach and for using condoms with main and other partners. Results. Toward the end of the study, 77% of injection drug users in the intervention area reported bei...

Applying the Transtheoretical Model to the Study of Exercise on Prescription

Abstract: This study examines the application of key constructs of the transtheoretical model and an integrated perceived barrier construct to exercise behaviour Research participants were middle-aged, sedentary, males and females (N = 393) who were referred by their general practitioner for a three-month prescription of exercise Partial support for the use of the transtheoretical model in a UK sample was found The decisional balance measure, in particular the cons of exercising, reflected hypothesized differences across the stages of change However, in contrast to previous studies, scores on efficacy items were not significantly associated with stage A potentially influential effect of barriers to exercise on different stages of behaviour was evident Implications for recruitment, intervention and research are discussed

Gender and ethnic differences in readiness to change smoking behavior.

Abstract: The Transtheoretical Model has been used extensively to investigate smoking behavior. However, gender and ethnic differences in key constructs of the Transtheoretical Model have not been fully evaluated. This gap in the literature is addressed in this brief report. We examined gender and ethnic differences in stages of change (readiness to quit smoking), perceived pros (benefits) and cons (costs) of smoking, and self-efficacy (confidence) in ability to quit among smokers seeking cessation treatment. Participants were 330 smokers ages 18 to 75, who responded to advertisements for a free minimal-contact smoking cessation program. Thirty percent of women were confident they could quit smoking compared to 53% of men. Women reported more pros of smoking and more cons of smoking than men. White smokers reported more pros of smoking than African smokers. These findings highlight the need to bolster quitting confidence among women and to identify alternatives to the pros of smoking relevant to women smokers.

A Partial Test of the Transtheoretical Model in Therapy with Adult Survivors of Childhood Sexual Abuse.

Abstract: This study tested the application of the transtheoretical model to therapy with adults who were sexually molested in childhood. Eighty-three adults currently in therapy and dealing with issues of childhood sexual abuse responded to questionnaires assessing their current stages of change in therapy and their relative use of different processes of change. Participants in the contemplation, preparation, and action stages reported significant differences in use of behavioral processes of change but no difference in their use of experiential processes. The pattern of change reported by these participants lends some support to the applicability of the transtheoretical model to this population and supports prior clinical description of therapy with sexually abused clients.

A stage-matched smoking cessation program for pregnant smokers.

Abstract: Pregnancy may be an optimal opportunity for targeting smoking in women, since this may be the only time in a woman’s life she receives frequent contacts with health care providers with a primary focus on initiating or maintaining health-enhancing behavior in herself. Therefore, prenatal health care may serve as a natural opportunity or powerful "teachable moment" to decrease cigarette smoking, especially in underserved women. An innovative stage-matched intervention program based on the Transtheoretical model is currently being implemented in six public maternity clinics in a southern New England city. These prenatal settings serve culturally diverse and economically disadvantaged individuals.

Exercise Stage of Change and Self-Efficacy in Primary Care: Implications for Intervention

Abstract: Multiple chronic diseases are caused or complicated by a sedentary lifestyle. Thus, an important and challenging application of psychology in clinical settings is changing the behavior of sedentary primary care patients. This study focused on exercise stage of change and self-efficacy in a sample of adult family practice patients recruited while waiting for their scheduled physician appointment. Regarding exercise stage of change, 15% of respondents were in the Precontemplation stage, 26% in the Contemplation stage, 50% in the Preparation stage, 7% in the Action stage, and 13% in the Maintenance stage. Mean self-efficacy scores for exercise were significantly higher among respondents in the Action and Maintenance stages of change. These cross-sectional data are consistent with the hypothesis that movement through the exercise stages of change could be encouraged by clinical interventions that increase exercise self-efficacy. The identification of multiple personal opportunities for increasing exercise self-efficacy may be clinically useful in this context. Recommendations for psychologists in primary care settings in their work with physicians are offered.

Readiness for change: implications for patient care.

Abstract: The strategic position of pharmacists within the community allows frequent interactions with many patients, thus making pharmacists potentially valuable resources for assisting patients in making behavioral changes regarding adherence to treatment. The Transtheoretical Model is a behavior-change model that provides a functional approach through which pharmacists can help patients to reach specific behavioral goals. The model is described and stage-specific examples of patient-pharmacist dialogue are provided to show how the model may be used to promote progression through the stages.

Facilitating behavior change. Use of the transtheoretical model in the occupational health setting.

Abstract: 1. Researchers have identified five stages of change and the 10 experiential and behavioral processes most effective in helping people move from one stage to the next. This model is referred to as "transtheoretical" because it encompasses many theories of behavior change. 2. Each stage of change tends to be characterized by the use of specific processes. Experiential strategies are used most frequently by individuals in the contemplation and preparation stages of change. Behavioral processes are used most frequently by individuals in the action and maintenance stages. 3. The transtheoretical model assists providers in developing interventions targeted not only for employees who are prepared to take action, but also for the majority of the population who are not yet intending to change their behavior, or for those who are only considering a lifestyle change. 4. Using this information, the occupational health nurse can design specific interventions targeted to an individual's current stage of change, with the potential to accelerate the employee's progress toward increasing the adoption and maintenance of the desired behavior.

Sexual behaviour change associated with a college HIV course.

Abstract: This study examined the effects of a multidisciplinary, multi-media college course, The HIV Pandemic and AIDS, on the knowledge, attitudes and behaviours of students. A quasi-experimental design was implemented using pre- and post-questionnaires administered to students enrolled in the course and to two control groups (N = 131) similar in age, gender, degree programme and class. At pre-testing, over 80% of students involved in relationships of four months or more reported having genital intercourse without a condom occasionally or frequently in the last year. Post-test results indicated HIV course participants changed more risk-related behaviours and felt less vulnerable to contracting HIV than the control group. Significant differences reported by course-enrolled students in comparison to the control group included discussing safe sex with a potential partner at a higher rate, becoming more selective about partners, and learning more about HIV. The dangers of presumed monogamy are discussed in relation to the transtheoretical model of change and the development of future HIV courses.

Application of the transtheoretical model of change to psychological skills training in intercollegiate athletes

Abstract: Although there is empirical and anecdotal evidence for the efBcacy of athletic performance enhancement interventions, a relatively small percentage of athletes take advantage of sport psychology services. It is likely that athletes perceive potential gains and losses in pursuing mental skills training, and the latter may adversely impact athletes' motivations and behaviors regarding consulting a sport psychologist. In order to increase the number of athletes who can benefit fi-om mental skills training, athletes' motivations and behaviors regarding sport psychology consultation must be addressed. The Transtheoretical model of change focuses on the related issues of motivation and behavior change through the constructs of the Stages of Change, Processes of Change, Decisional Balance, and Self-EfBcacy. Although the Transtheoretical model has been applied to a variety of behaviors, it has not been applied theoretically or empirically to the area of sport psychology consultation. In an attempt to apply the Transtheoretical Model to this area, questionnaires assessing Stage of Change, Decisional Balance, and Self-EfiBcacy were developed and cross-validated on two samples (total N = 308) of NCAA Division I Intercollegiate Athletes. The measures showed good internal reliability, with all but one subscale yielding an alpha coeflBcient of .79 or above, and good construct validity, exhibiting hypothesized relationships among each other and with relevant outcome variables. Finally, the Stage of Change measure exhibited a strong relationship with sport psychology consultations initiated by athletes during the 12 months following questionnaire administration. Of those athletes in the Precontemplation stage, 21% initiated an individual sport psychology