Stage of motivational readiness: predictive ability for exercise behavior

Assessing transcultural validity of the transtheoretical model with Chinese Americans and physical activity

Transtheoretical model has shown promise in promoting adoption and maintenance of physical activity and was used to guide this study. A cross-sectional design with snowball sampling was applied to recruit 201 Chinese Americans. Self-efficacy scores were significantly higher for participants in maintenance than those in precontemplation. There were no significant differences in perceived benefits and barriers in different stages. The transtheoretical model partially applied to the participants for whom the reinforcement of self-efficacy is more important than emphasizing the benefits or decreasing the barriers to regular physical activity. Cultural issues may play a critical role and should be further investigated.

The systematic development of a tailored e-mail intervention for health behavior change toward increasing intentional physical activity

Although the benefits of physical activity are well known, most adults in the United States are relatively sedentary, with about 60% of adults not regularly physically active and 25% of those not active at all. This inactivity places the population at risk for many chronic diseases. Understanding optimal ways of both communicating with and educating employees regarding intention to reduce risk of ill health and enhance well-being through physical activity was the fundamental aim of this health communication research study. The authors designed a series of theory-based, tailored e-mail messages, which were evaluated for content validity by health care experts and focus groups. Focus groups were held according to the stage-of-change level of the participants, and two clear domains emerged: persuasion and decision domains. Improving societal well-being in a cost-effective manner using e-mail remains to be seen; however, creating interventions to engineer sufficient impact on health behavior decision making is an investment worth exploring.

Long-term effects of a stage-based intervention for changing exercise intentions and behavior in older adults

PURPOSE

We examined the efficacy of an intervention tailored to the individual's stage of change for exercise adoption on exercise stage of change, physical activity, and physical function in community-dwelling older adults.

DESIGN AND METHODS

We randomized participants to a print and telephone intervention or a contact comparison group. Through the use of longitudinal analyses we examined the intervention's effectiveness in promoting stage progression, altering decisional balance and the processes of change, increasing self-efficacy and physical activity, and improving physical function among older adults who completed the 24-month study (N = 966). We conducted similar analyses that excluded individuals who were in maintenance at baseline and 24 months.

RESULTS

At the end of the study, there were no differences in stage progression, self-efficacy, decisional balance, the processes of change, physical activity, or physical function by intervention assignment. When the analyses excluded those participants (n = 358) who were in the maintenance stage for exercise throughout the intervention, we found that, compared with the comparison group, a greater proportion of individuals who received the exercise intervention progressed in stage by 24 months. Conversely, more individuals in the comparison group remained stable or regressed in stage compared with the intervention group.

IMPLICATIONS

Results indicate that a tailored intervention is effective in increasing motivational readiness for exercise in individuals who were in stages of change other than maintenance.

Evaluation of social-cognitive versus stage-matched, self-help physical activity interventions at the workplace

PURPOSE

To compare the effectiveness of stage-matched vs. social-cognitive physical activity interventions in a work setting. Both interventions were designed as minimal-contact, self-help programs suitable for large-scale application.

DESIGN

Randomized trial. Participants were randomized into one of the two intervention groups at baseline; the follow-up assessment was conducted 1 month later.

SETTING

A large, public university in the southeastern region of the United States.

SUBJECTS

Employees from two academic colleges within the participating institution were eligible to participate: 366 employees completed the baseline assessment; 208 of these completed both assessments (baseline and follow-up) and met the compliance criteria.

INTERVENTION

Printed, self-help exercise booklets (12 to 16 pages in length) either (1) matched to the individual's stage of motivational readiness for exercise adoption at baseline or (2) derived from social-cognitive theory but not matched by stage.

MEASURES

Standard questionnaires were administered to assess stage of motivational readiness for physical activity; physical activity participation; and exercise-related processes of change, decisional balance, self-efficacy, outcome expectancy, and goal satisfaction.

RESULTS

The two interventions were equally effective in moving participants to higher levels of motivational readiness for regular physical activity. Among participants not already in maintenance at baseline, 34.9% in the stage-matched condition progressed, while 33.9% in the social-cognitive group did so (chi2 = not significant). Analyses of variance showed that the two treatment groups did not differ in terms of physical activity participation, cognitive and behavioral process use, decisional balance, or the other psychological constructs. For both treatment groups, cognitive process use remained high across all stages, while behavioral process use increased at the higher stages. The pros component of decisional balance did not vary across stage, whereas cons decreased significantly between preparation and action.

CONCLUSIONS

Minimal-contact, one-shot physical activity interventions delivered at work can help people increase their participation in regular physical activity. Stage matching may not necessarily add value to interventions that otherwise make good use of behavior change theory. The findings also reinforce the importance of barrier reduction in long-term adherence. A limiting factor in this study is that employees in the earliest stage of change (precontemplation) were not well-represented in the sample.

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

OBJECTIVE

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.

DESIGN

A descriptive and cross-sectional design was used.

SAMPLE

A convenience sample included 108 primary family caregivers of mentally ill patients receiving home care from a psychiatric hospital in southern Taiwan.

MEASUREMENTS

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.

RESULTS

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.

CONCLUSIONS

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.