Transtheoretical Model

The Transtheoretical Model (TTM) has gained widespread popularity and acceptance, yet little is known about its effectiveness as a basis for health behavior intervention. A systematic review was conducted in order to evaluate the effectiveness of TTM interventions in facilitating health-related behavior change. Thirty-five electronic databases, catalogues, and internet resources were searched for relevant studies. In addition, the bibliographies of retrieved references were scanned for further relevant publications and authors were contacted for further information where necessary. Thirty-seven randomized controlled trials, targeting seven health-related behaviors, satisfied the inclusion criteria. Overall, the methodological quality of trials was variable, and there was limited evidence for the effectiveness of stage-based interventions as a basis for behavior change or for facilitating stage progression, irrespective of whether those interventions were compared with other types of intervention or with no intervention or usual care controls. The theoretical and practical implications of these findings are discussed.

Guided by H. theory of behavior and the transtheoretical model, the study purpose was to examine differences in psychosocial variables and external conditions by stage of mammography adoption. Sampled from a statewide population, participants (N ϭ 509) were women aged 51-80. They had been contacted by telephone, screened for eligibility (e.g., no history of cancer or recent mammogram), and interviewed 3-6 months later. Higher utility beliefs, social influences, and practitioner interactions about mammography were associated with improved stage of adoption, as were lower negative affect and external barriers regarding mammography. Higher decisional balance scores, with and without negative affect toward mammography, were associated with improved stage. Controlling for variables reflecting pros and cons, negative affect toward mammography further distinguished among stages. A richer set of pros and cons measures could explain screening more fully.

Studies focusing on the readiness of persons to change have burgeoned in recent years. Assessing readiness for change is viewed as important for interventions aimed at promoting health behaviors, such as smoking cessation and substance abuse programs. This study is the first to examine readiness for change, as conceived by Prochaska and his colleagues, among a sample of persons with severe mental illness who were about to participate in a vocational rehabilitation program. We examined the reliability, validity, and other psychometric properties of the Change Assessment Scale and its ability to predict attrition and actual change.

Key Words: coronary heart diseases, smoking cessa-Background. To explore possibilities for health edution, attitude, social influence, self-efficacy expectations, Transtheoretical Model, ASE model. cation, this study analyzed the differences in motives regarding smoking cessation of cardiac inpatients in various motivational phases. The Attitude-Social influence-Efficacy Model (ASE model) was used to as-

Based on a biomechanical model, an adequate body posture can contribute to the prevention of back pain and back pain chronicity. This study examines the explanatory value of the Transtheoretical Model (TTM) for the adoption of adequate postural habits in a cross-sectional sample of 149 employees of a German administration unit (mean age 40.2 years, 50% female). Using newly developed instruments with satisfactory psychometric properties, basic assumptions of the TTM could be confirmed: self-efficacy and the perceived pros for maintaining a good body posture increased significantly across the stages, while the perceived cons decreased. Additionally, the use of preventive strategies for back pain prevention increased linearly and significantly across the stages of change. The study supports the applicability of the TTM for postural behavior. Considering stages of change as an intervening variable may contribute to clarifying the relationship between participation in low back schools and prevention of back pain chronicity. Longitudinal and intervention study data are needed to support these assumptions.

Objective: Over 40% of Americans are sedentary and of those beginning an exercise program, 50% will drop out within 6 months. The Transtheoretical Model (TTM) is commonly used to describe exercise behavior and develop interventions for the initiation of exercise behavior. Less is known, however, about maintenance of exercise behavior and the construct associations for the action, maintenance, and termination stages of change. Thus, the purpose of this study was to examine which of the TTM constructs (i.e. decisional balance, processes of change, barriers-efficacy, and temptation) best distinguishes between the action, maintenance, and termination stages of change for men and women. Methods: Questionnaires measuring each of the TTM constructs were collected from 330 men (M ageZ27.14 years) and 380 women (M ageZ24.80 years). Data were examined for sex differences and subsequently, two forward logistic regressions were conducted for each sex such that the dependent variables for the regressions were action/maintenance and maintenance/termination. Results: Compared to men, women reported significantly less barriers-efficacy (pZ.04), greater pros of exercise (pZ.004), and greater use of behavioral (pZ.001) and experiential (p!.001) processes of change. For the men, affect temptation was the only significant correlate of action/maintenance (pZ.02), while barriers efficacy (pZ.001), environmental evaluation (pZ.02), and affect temptation (pZ.03) were associated with maintenance/termination. For the women, environmental reevaluation (pZ.02) and social liberation (pZ.05) were associated with action/maintenance, while barriers-efficacy (pZ.003) was the only construct correlated with maintenance/termination. Psychology of Sport and Exercise 6 (2005) 629-641 www.elsevier.com/locate/psychsport 1469-0292/$ -see front matter q (Elizabeth A. Fallon).

Data from three outpatient studies of treatment of marijuana dependence were used to test whether behavior change parallels stage movement in the transtheoretical model of change (TMC). This study examined one putative assumption of the TMC: individuals remaining in the preaction stages of change (i.e., precontemplation and contemplation) across time would show little change in their marijuana use. The University of Rhode Island Change Assessment (URICA) measure and two recent stage assignment algorithms were utilized to assess TMC stage status at baseline and end of treatment. The primary analyses employed paired-sample t tests of statistical equivalence and sign tests, and 34 out of the 36 tests demonstrated that individuals remaining in the preaction stages of change over the treatment period showed clinically important and statistically significant treatment outcomes. Clinicians and researchers should exercise caution in their use of URICA-based indices as meaningful markers of the recovery process. Better methods to measure stage status and test the TMC are needed if the model is to be used to guide substance abuse interventions.

Recovered problem gamblers N 37 described the processes used in overcoming their gambling problem using a modified version of the Processes of Change Questionnaire (J. O. Prochaska, W. F. Velicer, C. C. DiClemente, & J. S. Fava, 1988). The most frequently used processes were cognitiveexperiential in nature and included self-reevaluation, environmental reevaluation, dramatic relief, and self-liberation. The least-used processes were reinforcement management and social liberation. Individuals who had sought gambling treatment reported greater use of most processes, in particular cognitive-experiential ones, compared with self-changers. The processes reported by participants were similar to those elicited through open-ended questions, but the results for problem gamblers differ from results of studies of other types of behavior change. D

This document provides an overview of the origins, evolution, debate, and current applications relevant to the Transtheoretical Model (TTM), also known as Stages of Change (SoC) and relevance to role-playing games. It includes some of the debate about the viability, or argued lack thereof, for programs based on the TTM in any setting. The paper also includes suggestions for the potential relevance this model may have in the development and use of recreation education and therapeutic recreation interventions and role-playing games. Additionally, this paper includes some examples of potential implementations based on the TTM / SoC approach. Using the TTM as a guide from a TR perspective, it may be possible to develop a graduated series of role-playing gaming interventions for various populations.

How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key transtheoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages-precontemplation, contemplation, preparation, action, and maintenance-and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a transtheoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.

How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key transtheoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages-precontemplation, contemplation, preparation, action, and maintenance-and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a transtheoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.

Objective: Investigate the relationship between physical activity and components of the Transtheoretical model (TTM), in an older clinical population. Method: 85 people with Type 2 diabetes and/or cardiovascular disease (age 64.8 AE 8.2 yrs) completed TTM questionnaires. Physical activity was assessed using the 7-day recall questionnaire. Results: Differences across stage of change were found for physical activity, self-efficacy, the pros of more physical active and 5 processes of change. Physical activity, self-efficacy and the pros of more activity were greater in the maintenance than contemplation stage. Stage differences in processes were: consciousness raising (increased contemplation to action), self-liberation (increased contemplation to maintenance), helping relationships (increased preparation to maintenance), counter conditioning (increased contemplation to preparation, action and maintenance) and reinforcement management (increased contemplation and preparation to maintenance). Experiential processes were used more than behavioural processes in the preparation stage. Conclusions: Findings support the theoretical predictions of the TTM and the use of this model in older clinical populations.

Cardiovascular diseases are caused by multiple behavioral factors, including different dietary factors. We examined to what extent fruit, vegetable and fish consumption are related, and whether behavioral determinants vary across these dietary behaviors from a Transtheoretical model perspective. Data were collected among 1142 participants (T0; response rate 46%) selected from an Internet panel, who were followed-up one-week later (T1; N = 1055, response rate 92%). Mean age was 35.4 (SD = 11.9) years, 35% was male, and most respondents were of Dutch origin (90%). Of the respondents, 13%, 44% and 43% had a low, medium or high level of education, respectively. Electronic questionnaires assessed fruit, vegetable and fish intake (food frequency questionnaires), stages of change, decisional balance and self-efficacy, for each of these three behaviors. Stages of change and (changes in) fruit, vegetable and fish intake were only weakly associated; decisional balance and self-efficacy were m...

The application of theory to practice can be challeng-ing. This article describes the experiences of one organi-zation in applying the Transtheoretical Model (TTM) to a health promotion program for older adults, HealthStages. The concepts of the model, especially stage of change, ...

Intimate partner violence (IPV) victimization is a women's health problem that imposes a significant health and health care cost burden. Although IPV victims cannot change the perpetrator's behavior, they can take actions to reduce exposure to the partner's abuse. The process of change for IPV victims has been described using the transtheoretical model (TTM), among others. We report results of a qualitative study with current and past IPV victims to 1) explicate the process of safety-seeking behavior change for female victims of IPV and 2) explore the fit of the TTM for explaining this process. Based on the results, we propose the psychosocial readiness model to describe the process of change for female victims of IPV. This model considers readiness as a continuum that ranges from robustly defending the status quo on 1 end to being ready to take action toward change on the other. Movement toward and away from change along the continuum results from a dynamic interplay of both internal factors and external interpersonal and situational factors.

Purpose: To evaluate the application of a transtheoretical model (TTM) of behavioral change to adolescent reproductive health counseling. Methods: Family planning counselors in Boston Metro school-based and community health centers used a TTM for pregnancy and human immunodeficiency virus/sexually transmitted disease (HIV/ STD) prevention. Data were collected from September 2000 through December 2001. Bivariate analyses using chi-square statistics and multivariate analyses using logistic regression were performed to identify the differences between stage of change (SOC) groups and the predictive variables for SOC movement. Results: Data on 539 sexually experienced clients were examined. Site, client's gender, race, proximity of sexual activity, sexual partner status, level of partner support, and target behavior were significantly associated with initial SOC for both pregnancy and disease prevention (p Ͻ .01). For clients meeting stage movement analysis criteria (n ϭ 86 for pregnancy prevention; 128 for disease prevention), there was suggestive evidence that older ones were more likely to move forward for both pregnancy and disease prevention (p ϭ .08 and p ϭ .07, respectively) between their first and second visits. For disease prevention, those initially in the precontemplation/contemplation stages were more likely than those in the action/maintenance stages to be forward movers (odds ratio ϭ 3.89, p ϭ .06). Counselors/supervisors reported that the TTM helped structure an integrated message and increased client engagement. Conclusions: Efforts to prevent teen pregnancy and HIV/STDs should acknowledge the roles of partner support and age in SOC. Adolescents in preparation may need specific skill-building for behavioral change. Overall, TTM represents a promising approach to promoting integrated pregnancy and disease prevention in family planning counseling.

A consecutive sample (N=88) including outpatients suffering from anorexia (n=29), bulimia (n=32), and eating disorders not otherwise specified (n=27) was recruited from an eating disorders clinic with a low-threshold access. The patients' readiness to change their eating behavior ...

The purpose of this scholarship is to review the literature relative to applications of the Transtheoretical Model to exercise interventions, and to provide considerations for health professionals while using the Transtheoretical Model in their practice. The components of the Transtheoretical Model of behavior change are parsed and analyzed to review their function and role in the model. In addition, the model is reviewed to determine the effectiveness of applying the Transtheoretical Model in conjunction to interventions aimed at increasing physical activity behavior. In general, results support the application of Transtheoretical Model for physical activity behavioral change, but not unconditionally. Beyond highlighting results of studies applying the Transtheoretical Model, implications and considerations for interventions using the models are also detailed. When acknowledging the multidimensional nature of the model, it is important to demonstrate a good understanding of how the various dimensions relate to one another and recognize how these relationships will influence intervention development.

This study investigated the impact of a Critical Friends Group (CFG), an inquiry-based professional development model, on Turkish EFL teachers. It was acknowledged that short-term workshops did not provide opportunities for teachers to make connections between the theory presented and the implications that it had for classroom teaching. CFG model accompanied with protocols was thought to be a practical and efficient way of professional development.

Pregnant smokers represent a special population of women smokers. Since smoking affects both the mother and the unborn child, it might be hypothesized that pregnant women should be highly motivated to quit smoking during pregnancy. Results from both naturalistic studies and intervention studies have generally shown only modest changes in smoking during pregnancy. To help design more effective interventions tailored for this special population of smokers, more information is needed on how they differ from other smokers. The current study was designed to examine patterns and differences on constructs of the Transtheoretical Model between low-income culturally diverse pregnant and nonpregnant female smokers. Groups were compared on the distribution of the stages of change. In addition, stage and group comparisons were conducted for the pros and cons of smoking, situational temptations to smoke, and the processes of change. The sample included 103 economically disadvantaged, culturally diverse pregnant women and a matched group of 103 nonpregnant women smokers. Pregnant smokers as a group were similar to their nonpregnant peers on their readiness for quitting. In general, the patterns observed across the stages of change were consistent with those seen in other populations of smokers. The primary difference found between the groups were on the cons of smoking, habit-related temptations to smoke, and experiential processes of change. Specifically, pregnant women perceived a less negative attitude toward their smoking, were more tempted in habit-related situations, and made less use of important experiential processes of change. The implications of these findings for designing interventions tailored for this special group of smokers are discussed.

Several authors have reflected on the underdeveloped state of organizational change theory, research, and practice. This field needs an integrative framework that can synthesize major approaches to change. The Transtheoretical Model has the potential to do for organizational change what it has done for individual behavior change. Conceptually the stages-of-change dimension can be used to integrate principles and processes of change from divergent models of change. Practically, the stages-of-change dimension can be applied by leaders to reduce resistance, increase participation, reduce dropout, and increase change progress among employees.

exercise domain. Implications of the findings are dis-Background. The purpose of this study was to test the cussed and future directions for researchers, pracability of the Transtheoretical Model (TTM) to predict titioners, and program planners are provided. ᭧ 2001 exercise stage transition of individuals in a large, American Health Foundation and Academic Press untreated-population-based, random sample of Cana-Key Words: Transtheoretical Model; stages of change; dian adults (18-65 years of age) over two consecutive physical activity; exercise behavior; behavior change. time periods.

Objective: This study examines smoking cessation intervention materials that are based on the transtheoretical model from a content-based perspective. Methods: Data of 2 population-based intervention studies with total N = 1044 were used. Analyses compared how many unique intervention materials could be generated theoretically and how many unique intervention materials were needed empirically. Results: The intervention system was able to generate theoretically a total of 1040 unique intervention materials with normative feedback only, and almost half a million unique intervention materials with normative and ipsative feedback. This variability was needed empirically. For smokers in precontemplation, all possible intervention materials were used. For smokers in contemplation, preparation, action, and maintenance, intervention materials were hardly created more than once. Conclusion: Using the transtheoretical model to create tailored intervention materials yields an enormous variability of tailoring. However, tailoring for precontemplation needs improvement. Additional tailoring variables for precontemplation could be long-term quitting plans, intention to reduce smoking, experiences with past behavior, or severity of nicotine dependence.

The development and use of validated processes of change (POC) measures have received little attention in the literature despite their importance in the Transtheoretical Model. Using survey data (n=2909), we examined the construct validity of a 22-item mammography POC scale by testing for factorial validity and factorial invariance across stage of change. We also used MANOVA with tukey post-hoc tests to confirm stage differences in POC use (concurrent validity). Our results confirm the a priori correlated four-factor structure of this scale and provide some support for the measurement equivalence of this scale across stage, supporting comparisons of POC use across stage.

Interventions are increasingly described as theory-based; however, the basis for this is often not clear. Advancing behavioural science requires a good understanding of how interventions are informed by, and test, theory. This study aims to develop a reliable method for assessing the extent to which behavioural interventions are theory-based.

All U.S. adults are advised to exercise regularly and from Transtheoretical Model-based interventions maintain a healthful body weight, yet the majority of focusing on regular moderate exercise. Current stages the population is overweight [1-3] and 40% engage in of change measures assessing regular moderate exerno leisure-time physical activity [3]. Improving these cise specific to an overweight population (BMI Ն25) are rates poses a significant public health challenge. The lacking. This study examined the validity of a staging algorithm for moderate exercise for the purposes of National Institutes of Health have recommended that healthy weight management.

This pilot study (a) examined the stages of change (SOC) for condom use with primary and casual partners among rural heterosexual African American stimulant users, (b) identified gender differences in variables associated with SOC, and (c) assessed the association of SOC with decisional balance and self-efficacy. Seventy-two participants completed the study. SOC with a primary partner was much lower than SOC with a casual partner, indicating more consistent condom use with casual partners. Significant gender differences existed in decisional balance for condom use for both primary (p = 0.02) and casual partners (p = 0.03), with women having higher decisional balance scores than men. Women also reported higher self-efficacy scores for condom use with casual partners than men. In regression models, age, decisional balance, and self-efficacy were significantly associated with SOC for condom use with a primary partner; however, only self-efficacy was significantly associated with SOC with casual partners. The findings provide support for the development of interventions that promote the advantages of and increase self-efficacy for condom use.

The rising tide of obesity erodes the health of youths and many times results in adult obesity. The purpose of this investigation was to examine the effectiveness of an eight-session health promotion/ transtheoretical model Internet/video-delivered intervention to increase physical activity and reduce dietary fat among low-income, culturally diverse, seventh-grade students. Those who completed more than half the sessions increased exercise, t(103) = À1.99, p = .05, and decreased the percentage of dietary fat, t(87) = 2.73, p = .008. Responses to the intervention by stage of change, race, and income are examined. D

This paper describes a novel approach to systems analysis and design (SA&D) based upon the transtheoretical model of behavioral change (TTM). TTM was developed for the purpose of helping clinicians and patients change behaviors related to health such as smoking and exercise. The application of TTM to SA&D described here is appropriate when one of the key rationales for developing a new system is to alter user behavior with respect to task performance, particularly when use of the system will be optional. The key strengths of TTM include a structured approach to understanding behavioral change, concrete metrics that can be developed to measure specific behavioral change processes, and clear guidelines for the use and timing of various mechanisms for fostering change. This paper describes a system design in the field of educational technology designed to foster the use of best practices with respect to multiple-choice question writing, delivery, and analysis.

Several authors have reflected on the underdeveloped state of organizational change theory, research, and practice. This field needs an integrative framework that can synthesize major approaches to change. The Transtheoretical Model has the potential to do for organizational change what it has done for individual behavior change. Conceptually the stages-of-change dimension can be used to integrate principles and processes of change from divergent models of change. Practically, the stages-of-change dimension can be applied by leaders to reduce resistance, increase participation, reduce dropout, and increase change progress among employees.

The Transtheoretical Model of Change offers a promising stage-based approach to client–treatment matching to increase the efficacy of batterer treatment. This paper describes the development and validation of the URICA–Domestic Violence (URICA-DV), a four-dimensional stage measure assessing batterers' readiness to end their violence. Two hundred fifty-eight batterers in treatment at two Rhode Island agencies completed a questionnaire that included the

Objective: For women who are experiencing intimate partner violence (IPV), making changes toward safety is often a gradual process. When providing counseling and support, health care providers may benefit from better understanding of where women are in their readiness to change. Our objective was to apply the transtheoretical model's stages of change to the experiences of women who experienced IPV and map their experiences of change as they moved toward increased safety. Methods: A multi-disciplinary team designed a qualitative interview process with 20 women who had current or past histories of IPV in order to explore their experiences. Results: The women in our study (1) moved through stages of readiness generally in a nonlinear fashion, with varying rates of progression between safe and nonsafe situations, (2) were able to identify a ''turning-point'' in their situations, (3) attempted multiple ''action'' steps and (4) were influenced by internal and external factors. Conclusions: Our study suggests that focusing on the transtheoretical model to develop stage-based interventions for IPV may not be the most appropriate given the nonsequential movement between stages and influence of external factors. Practice implications: The ''change mapping'' technique can be used as an educational and counseling tool with patients, as well as a training tool for health care providers. #

Recent interest in the construct of motivation to change among male perpetrators of intimate partner violence (IPV) has led to development of two self-report measures of this construct: the University of Rhode Island Change Assessment for Domestic Violence (URICA-DV; and the Safe at Home Inventory (SAH; . We examined the internal structure of these instruments using confirmatory and exploratory factor analyses in a sample of 199 male IPV perpetrators waiting to begin court-mandated batterer intervention programs. Results indicated that the scales had adequate internal consistency. However, using confirmatory factor analyses, the hypothesized structural models of each instrument fit the data poorly. Subsequent models suggested by a series of exploratory factor analyses failed to improve model fit substantially for both scales. For the URICA-DV, a 3-factor model including items from the Precontemplation, Contemplation, and Action subscales fit the data adequately. No acceptable model fit could be found for the SAH. Intercorrelations among similar subscales across the two inventories suggested only a modest degree of intercorrelation (r's=0.16-0.52), and a factor structure more dependent on scale of origin than item latent content, suggesting that the scales assess different facets of the readiness to change construct. These results suggest that before the stages of change construct can be fully applied to the IPV area, more research and evaluation are needed on how to accurately assess abuser readiness to change.

Brief, validated, and reliable theory-based measures specifically designed for use in large survey research with adolescent populations are needed to assess attitudes and behaviors about dietary fat consumption. This study validated two transtheoretical model (TTM)-based instruments in 2639 ninth graders from 12 Rhode Island high schools. The Decisional Balance Questionnaire for Adolescent Dietary Fat Reduction (DBQA) measures the importance adolescents assign to the pros and cons of reducing dietary fat consumption, while the Situational Temptations Questionnaire for Adolescents (STQA) measures temptations to eat high-fat foods as both a global construct and across three categories of challenging situations. Four competing models were compared for each instrument. An eight-item, correlated two-factor Pros and Cons model was validated for the decisional balance measure and a nine-item, three-factor hierarchical model was validated for situational temptations. The theoretically predicted relationships between stage of change and the pros and cons, as well as stage and situational temptations were supported. These results demonstrate that both measures have sound psychometric properties and are externally valid. D

The Processes of Change are the cognitions, behaviors, and emotions that people employ to change their behaviors. However, the processes of change remain the least studied dimension of the transtheoretical model. The present study presents a psychometric evaluation of the short form of the processes of change inventory for smoking cessation in an adolescent sample of 798 ninth-grade smokers from 22 Rhode Island high schools. The majority of the sample was white (87.2%), split approximately evenly as regards to gender (48.1% female), with an average age of 14.3 (SD = 0.6) years of age. The same hierarchical model established on the adult sample was fit to the 20-item inventory. This model included 10 primary factors representing the processes of change and two second order factors that grouped the processes into five behavioral and five experiential processes of change. Model fit indices (RMSEA= 0.08, CFI = 0.92) supported the hypothesized structure. External validation was established by testing for stage differences in the use of the ten processes. A significant MANOVA ( F(4, 793) = 18.517, p b 0.001) and separate ANOVAs demonstrated that the use of all ten processes increased across the stages, as predicted by the transtheoretical model of behavior change. The processes of change help guide researchers, clinicians, and intervention program developers towards effective strategies to assist individuals at all stages of change progress towards healthier behaviors. D

This study investigated the associations among history of depression, current depressive symptoms, and constructs of the Transtheoretical Model (TTM) of change: stages of change, decisional balance, temptation, and processes of change for smoking cessation. Participants were 239 current smokers (70.7% male, 49.8% African-American, mean cigarettes per day = 19.8, 42.3% were in precontemplation). Results showed that participants with a history of depression reported higher current depressive symptoms. No significant relationship was observed between stages and history or current level of depressive symptoms. Current depressive symptoms, rather than depression history, was related to other TTM constructs: pros of smoking, temptation to smoke under habitual and negative affect situations, and the self-reevaluation process of change. D

This paper describes a novel approach to systems analysis and design (SA&D) based upon the transtheoretical model of behavioral change (TTM). TTM was developed for the purpose of helping clinicians and patients change behaviors related to health such as smoking and exercise. The application of TTM to SA&D described here is appropriate when one of the key rationales for developing a new system is to alter user behavior with respect to task performance, particularly when use of the system will be optional. The key strengths of TTM include a structured approach to understanding behavioral change, concrete metrics that can be developed to measure specific behavioral change processes, and clear guidelines for the use and timing of various mechanisms for fostering change. This paper describes a system design in the field of educational technology designed to foster the use of best practices with respect to multiple-choice question writing, delivery, and analysis.

Prochaska and DiClemente's Transtheoretical Model predicts dropout from substance-abuse treatment. However, it is not known whether readiness to quit smoking is associated with attrition from drug treatment programs with smoking restrictions. This study examined the relationship between smoking characteristics, smoking stage of change, and both length of stay (LOS) and discharge type among 75 perinatal substance abusers attending a smoke-free residential treatment program. URICA scores predicted LOS ( P=.0004) and discharge type ( P=.01). Women in action and maintenance remained in treatment longer and were more likely to complete treatment compared to those in precontemplation. Findings were not accounted for by addiction severity. Women with little interest in quitting smoking may have difficulty adhering to smoking restrictions during treatment for other drug problems, resulting in increased attrition. Alternatively, smoking stage of change may be a ''proxy'' for overall readiness to change in this population. D

The processes of change dimension of Prochaska and DiClemente's transtheoretical model of change is tested in a sample of opiate addicts for the first time. A self-report (The Processes of Change Inventory for Opiate Addicts, PCI-OA) designed to assess the frequency of processes of change was administered in a sample of 178 heroin addicts in order to study its reliability, validity and discriminative efficiency. An h-reliability coefficient of 0.87 was obtained. A principal component analysis of the measure revealed a three-component solution which accounted for 34% of the variance: 'contemplation and preparation processes', 'processes of action', and 'processes of the final part of the action phase and maintenance'. Comparisons between abstinent and non-abstinent subjects revealed significant differences (P B0.0001) in two of the ten processes considered: counterconditioning and stimulus control. A stepwise discriminant analysis yielded a linear combination of eight processes that correctly identified 78% of the total sample. Theoretical and clinical implications of the results are discussed, suggesting that the PCI-OA can be considered as a useful self-report instrument for identifying which processes of change are being used by a specific opiate-dependent patient.