Transtheoretical Model

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.

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 (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.

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.

Using a multivariate extension of the mediation framework, we examined the simultaneous effect of psychosocial variables hypothesized to mediate the relationship between a motivationally-tailored physical activity intervention, and 6-month physical activity behavior in 239 healthy, under-active adults (mean age=47.5; 82% women). Participants were randomly assigned to 1) Print-based feedback; 2) Telephone-based feedback; or 3) Contact Control. All mediation criteria were satisfied for both intervention arms. In terms of effect size, a moderate indirect effect of Print (0.39, 95% CI=0.21, 0.57) was due to increases in behavioral processes (0.54, 95% CI= 0.29, 0.80) being attenuated by decreases due to cognitive processes (-0.17, 95%CI= -0.31,-.03). A moderate indirect effect was observed for Telephone (0.47, 95% CI=0.28, 0.66), with increases due to behavioral processes (0.61, 95% CI=0.34, 0.87) attenuated by decreases due to cognitive processes (0.15, 95% CI=-0.27, -0.02); self-efficacy and decisional balance mediational paths did not attain statistical significance. These findings highlight the importance of studies that deconstruct the theoretical components of interventions to determine which combination produces the greatest behavior changes at the lowest cost.

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.

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

Background. Websites have the potential to deliver enhanced versions of targeted and tailored physical activity programs to large numbers of participants. We describe participant engagement and retention with a stage-based physical activity website in a workplace setting.

The ASE model, an integration of social psychological models, states that motivational phases and the transition from one phase to another can be predicted by behavioral determinants. The goal of the present study was to replicate the so-called O pattern that was found in earlier Dutch studies. In four cross-sectional studies (N = 918, N = 354, N = 225, N = 317), smokers filled in a questionnaire based on the ASE model, while the motivational phase question was based on the stage definitions from the Transtheoretical model. Precontemplating smokers perceived fewer advantages of quitting than contemplators. Precontemplators encountered less support for quitting than contemplators. Contemplators reported lower self-efficacy expectations than those in preparation, while this group had lower self-efficacy expectations than respondents in action. Ex-smokers in maintenance reported fewer disadvantages of quitting than those in action. Since changes in cognitive determinants are thought to...

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

Background. Curbing the epidemic of childhood and adolescent obesity requires impacting multiple behaviors. This article examines the interrelationships of physical activity, fruit and vegetable consumption, and limiting television time among elementary, middle, and high school students.

Clinical observations and recent studies suggest that arthritis patients vary considerably in their involvement in self-management efforts. In the literature on health promotion, there is growing recognition that patients may be at different stages of change with respect to the adoption of self-management strategies. The major goal of the present study was to examine whether cluster analysis could be used to identify homogeneous subgroups of patients having persistent arthritis pain based on their responses to a stages of change questionnaire. Participants in this study (103 patients having rheumatoid arthritis and 74 patients having osteoarthritis) completed a stages-of-change measure speci®c to adoption of a self-management approach to their arthritis. A cluster analysis identi®ed ®ve distinct subgroups of arthritis patients: (1) precontemplation ± 44% of the sample; (2) contemplation ± 11% of the sample; (3) preparation ± 22% of the sample; (4) unprepared action ± 6% of the sample; and prepared maintenance ± 17% of the sample. These subgroups are generally consistent with what might be expected based on the transtheoretical model of stages of change by Prochaska and DiClemente (Prochaska JO, DiClemente CC. Towards a comprehensive, transtheoretical model of change: states of change and addictive behaviors. In: Miller WR, Heather N, editors. Applied clinical psychology, 2nd ed. Treating addictive behaviors, New York: Plenum Press , 1998. pp. 3±24.), and may have important clinical implications. For example, it is possible that the arthritis subgroups identi®ed may predict arthritis patients' participation in and responsiveness to pain-coping skills training, exercise interventions, or other formal self-management training programs. Also, one may be able enhance the outcomes of self-management interventions for arthritis by tailoring treatment to the patient's particular stage. q

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.

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.

Background: Sedentary mothers are important to reach with physical activity promotion. Purpose: This study pilot tested "Moms on the Move," a Transtheoretical Model (TTM)-derived physical activity (PA) intervention for low-income mothers enrolled in the Women, Infants, and Children (WIC) program. Method: Sedentary mothers (N = 44) were randomized to (a) Moms on the Move (PA intervention) or (b) counseling on selfbreast examination (control). Pre-and posttest measurement (baseline and 2 weeks after the 8-week interventions) included (a) stage of PA behavior change, (b) PA behavior, (c) selected TTM constructs, and (d) social support. Pre-and postdifference scores, chi-square, and one-way analyses of variance (ANOVAs) were used. Results: The experimental group progressed in stage of change more than control, χ 2 (1, N = 44) = 20.50, p < .001. The experimental group had greater PA behavior: weekly minutes of PA, F(1, 42) = 46.85, p < .001; daily energy expenditure (EE), F(1, 42) = 23.01, p < .001; and weekly moderate PA EE, F(1, 42) = 32.63, p < .001. Experimental subgroup (n = 11) step counts increased pre-post, t(10) = 6.16, p < .001. An ANOVA showed that the experimental group had greater improvements in all TTM constructs and social support, ps < .001. Conclusions: WIC mothers are at risk for sedentary living and have not been targeted for PA behavior change using a provider-counseled approach. Although further testing is needed, Moms on the Move appears to be efficacious.

People don&#x27;t change because they can&#x27;t, don&#x27;t want to, don&#x27;t know how, or don&#x27;t know what to change. The transtheoretical model provides an integ-rative model for understanding reasons for not changing, as well as readiness to change. Stages and levels of change guide therapists in their work in helping clients change. Clients in the precontemplative stage typically cannot change without

Tobacco Dependence among smokers with psychiatric disorders has been under-addressed by the mental health, addictions, and tobacco control communities. This study examined depressed smokers' readiness to quit and the applicability of the Stages of Change framework to a psychiatric sample. Currently depressed smokers (N = 322) were recruited from four outpatient psychiatric clinics. Participants averaged 16 cigarettes per day (S.D. = 10) and 24 years (S.D. = 13) of smoking. The majority (79%) reported intention to quit smoking with 24% ready to take action in the next 30 days. Individuals in the preparation stage reported more prior quit attempts, a greater commitment to abstinence, increased recognition of the cons of smoking, and greater use of the processes of change. Precontemplators were least likely to identify a goal related to their smoking behavior. Depressive symptom severity and history of recurrent depressive episodes were unrelated to readiness to quit. This study is one of the first to examine the smoking behaviors of currently depressed psychiatric outpatients. The level and longevity of their tobacco use underscore the need for cessation interventions. The consistency in hypothesized patterns among theoretical constructs of the Stages of Change model supports the transfer of stage-tailored interventions to this clinical population.

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. #

Purpose: We test the efficacy of an intervention based on the transtheoretical model to increase the intake of fruits and vegetables and to describe differences in psychosocial variables based on the achievement of the 5 A Day Program target. Design and Methods: This study is a randomized controlled trial comparing a 12-month fruit and vegetable intervention to a control condition with a 12-month follow-up. Participants included 1,277 communityresiding persons who were 60 years of age or older; 834 provided dietary data at all three time points and are included in our outcome analyses. Results: The intervention group increased intake by 0.5 to 1.0 serving more than the control group over 24 months as measured by the NCI Fruit and Vegetable Screener and the 5 A Day Program screener. The majority of the participants (58%) perceived that they maintained 5 or more servings per day for 24 months. These maintainers had a higher intake at each time point for all dietary measures and differed from those who failed to progress (11%) for most transtheoretical model variables. Implications: The intervention was effective in increasing the intake of fruits and vegetables in older adults. Those who maintained their level of perceived intake as 5 or more servings per day consumed 2-4 servings per day more than those who failed to progress.

This paper reviews the Theory of Self-Efficacy, Transtheoretical Model of Readiness for Change, and Theory of Addictions to provide a basis for smoking cessation, and explores how these theories have been used to guide clinical research and clinical interventions. Selected randomized controlled trials of the past ten years are reviewed for demonstrated efficacy, integration of theory into the design of the interventions, and how theories guide analysis. Results show that surprisingly little effort has been put forth to examine and develop these theories within the context of clinical interventions, despite the claims of importance. For example, the relationship between stages of readiness of change and smoking cessation outcome has not been examined. Despite the complexity of smoking behaviors (quitting, relapsing, maintaining, occasional smoking and so on), the concept of self-efficacy was mostly measured on single occasions over the course of most studies reviewed; multiple measur...

Since 1987 when the first national survey of mamthe characteristics of women ages 50 to 80 who do not mography was conducted [1], the rate of mammography follow commonly accepted mammography screening utilization has doubled. Most of the increase occurred guidelines. It provides unique understanding of the in the 3 years following that initial survey [2]. The 1992 robustness of characteristics of underusers across five different U.S. subpopulations.

Aim To examine the population impact and effectiveness of the Pro-Change smoking cessation course based on the Transtheoretical Model (TTM) compared to standard self-help smoking cessation literature. Design Randomized controlled trial. Setting Sixty-five West Midlands general practices. Participants Randomly sampled patients recorded as smokers by their general practitioners received an invitation letter and 2471 current smokers agreed. Interventions Responders were randomized to one of four interventions. The control group received standard self-help literature. In the Manual intervention group, participants received the Pro-Change system, a self-help workbook and three questionnaires at 3-monthly intervals, which generated individually tailored feedback. In the Phone intervention group, participants received the Manual intervention plus three telephone calls. In the Nurse intervention group, participants received the Manual intervention plus three visits to the practice nurse. Measurements Biochemically confirmed point prevalence of being quit and 6month sustained abstinence, 12 months after study commencement. Findings A total of 9.1% of registered current smokers participated, of whom 83.0% were not ready to quit. Less than half of participants returned questionnaires to generate second and third individualized feedback. Telephone calls reached 75% of those scheduled, but few participants visited the nurse. There were small differences between the three Pro-Change arms. The odds ratio (95% confidence intervals) for all Pro-Change arms combined versus the control arm were 1.50 (0.85-2.67) and 1.53 (0.76-3.10), for point prevalence and 6month abstinence, respectively. This constitutes 2.1% of the TTM group versus 1.4% of the control group achieving confirmed 6-month sustained abstinence. Conclusions There was no statistically significant benefit of the intervention apparent in this trial and the high relapse of quitters means that any population impact is small.

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.

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.

Although the need for transplantation among African Americans is high, their donation rates are disproportionately low. This study describes the development and validation of culturally adapted psychosocial measures, including Transtheoretical Model constructs, Stages of Change, Decisional Balance, and Self-efficacy, related to deceased organ and tissue donation for an African American college population. Exploratory and confirmatory analyses for Decisional Balance and Self-efficacy measures demonstrated factor structures similar to previous studies of other behavioral applications, indicated excellent model fit and showed good internal and external validity. This study developed brief measures with good psychometric properties for an emerging behavior change domain in a new population.

The authors suggest that the mental health system of the nation could benefit by more fully embracing the idea of mutual-help (i.e., self-help), and this collaboration could be facilitated by the utilization of a well-established clinical theory to elucidate the psychological processes at work within mutual-help organizations. The processes of change of the transtheoretical model is offered as one potential framework. This well-established model has been used to help psychologists better understand clinical and professional phenemonena, but, to date, has been used less frequently with non-professional interventions. This article applies the ten processes of change of the transtheoretical model to mutual-help organizations, focusing on four groups, including Alcoholics Anonymous (AA), Oxford House, GROW, and Schizophrenics Anonymous. The advantages of the transtheoretical model and its potential ability to act as a common language across clinical professionals and mutual-help organizations are discussed. In addition, advantages of bolstering the present mental health system using combinations of both forms of care along the recovery continuum are described.

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.

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).

Objectives. To compare conceptually similar decision-making components from the theory of planned behavior (attitude) and the transtheoretical model (pros and cons) to determine the extent to which attitude towards exercise adds to the prediction of stage of exercise behavior beyond that of pros and cons.Method. A sample of college undergraduates (N=223) were given stage of change, attitude and decisional balance measures regarding their exercise behavior. Structural equation modeling (SEM) was used to test the underlying measurement structure of the decision-making components, while a series of discriminant function analyses (DFAs) was performed using a combination of pros, cons, and cognitive and affective attitudes as predictors of membership in one of the five stages of change.Results. SEM determined that a correlated four-factor model, which included pros and cons and two attitude subscales, provided the best fit to the data. The DFAs revealed that the addition of attitude components to pros and cons significantly increased the overall explained variance across the stages of change from 32% to 56%, and improved the predictive ability of pros and cons from 31.2% to 48.2%.Conclusions. Although conceptually related, pros, cons and attitude were not closely linked at a construct-measurement level. Furthermore, the addition of attitude to pros and cons increased the overall explained variance across stages of change and improved the predictive ability of pros and cons alone. The measurement model and DFA results taken in combination strongly suggest that the addition of cognitive and affective attitudes may strengthen the decision-making aspect of the transtheoretical model.

Background. This study evaluated the impact of a ing repeat mammography behavior, but more intensive telephone outcall intervention (based on the Transtheinterventions are likely to be necessary to promote beoretical Model) on screening mammography behavior havior change among nonadherent women. ᭧1998 Ameriamong lower income, older women.

Case management practices have continued to grow despite a lack of clear evidence of their efficacy. With the expanding segment of the elderly population, there is a critical need to develop and identify programs that will address the many needs of the aging. Geriatric Case Management has been the avenue selected by many health care providers to address these issues, focusing on maintaining health status and improving linkages with medical and community resources. Studies testing the effectiveness of these models have failed to demonstrate their effectiveness in reducing depression, reducing acute care service use, and improving or maintaining health status. The Geriatric Case Management models presented in these lack an evidence-based, theoretical framework that provides definition and direction for case management practice. This article introduces behavior change theories as a method of structuring and delineating the case management intervention. The Transtheoretical Model and the Theory of Planned Behavior are discussed and methods of integrating these theories into practice are discussed.

Although eating disorders cause severe somatic and psychological sequelae, a majority of affected patients are not motivated for treatment. The aim of this study was to assess stages of change in patients with eating disorders and to analyze their correlations with clinical characteristics and treatment processes using Prochaska&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s transtheoretical model of change. 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&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; readiness to change their eating behavior was assessed by a self-rating scale (URICA), and a score for each participant on each subscale (precontemplation, contemplation, action) was derived from the scale. Patients were introduced to a set of eight treatment processes over the course of four treatment sessions. During the four sessions, therapists rated whether or not patients appeared to be using each of the treatment processes. While diagnostic subtype, age, illness duration, and previous treatments were not associated with motivational stages, self-referral was positively correlated to treatment motivation. Emotional involvement, specific behavioral change processes, and beginning a continuing treatment were correlated with more advanced stages of change. This study supports the notion of the stages of change as an independent dimension that is relevant for the treatment of eating disorders. The lack of impact of previous, presumably nonspecific treatments on the stages of change underlines the importance to assess and to improve specifically patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; motivation. Therapeutic work towards the mobilisation of emotions with regard to their eating problem as a means to improve readiness to change should be examined in future studies.

The objective of this study was to review the evidence concerning stage-based dietary interventions in primary care among persons with diabetes or an elevated diabetes risk. Search strategies were electronic databases and manual search. Selection criteria were randomized controlled studies with stage-based dietary intervention, conducted in primary care with at least 6 months of follow-up, and participants with either type 2 diabetes or with an elevated risk. The researchers evaluated trials for inclusion, extracted data and assessed study quality. Seven articles, based on five data sets, were included. These studies concentrated on cardiovascular diseases and being overweight, not diabetes. The quality of the studies was moderate to weak. Inadequacies in the reporting often involved unspecific information on the training of health care providers. Long-term positive outcomes (compared with controls) were found in total and monounsaturated fat intake, diastolic blood pressure, health status and wellbeing. The existing data are insufficient for drawing conclusions on the benefits of the trans-theoretical model. More high-quality studies focusing on diabetes are needed, with greater attention to the training of providers and process evaluation. There is a need for a standardized appraisal tool for study evaluation, focusing separately on education interventions for patients and providers.

Background. Stage-based computer expert systems (CES), delivered in physician offices, may offer unique opportunities to combine high participation and high efficacy, resulting in a high public health impact. Applying this technology in settings serving low-income African-American smokers, with the addition of practical tools for stress reduction, may help to reduce disparities in morbidity and mortality from smoking-related diseases.

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...

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

African Americans (AAs) have the highest incidence rates of colorectal cancer (CRC) among all races in the US. These disparities may be attributed to lower participation in CRC prevention and control activities [e.g., flexible sigmoidoscopy (FS), fecal occult blood testing (FOBT)]. This is a current issue in East Harlem where less than half the residents in this area participate in CRC screening and mortality rates due to CRC are higher than the national average. We examined correlates of FS and FOBT screening among AAs based on the transtheoretical model (TTM) of behavior change. One hundred and eleven AA men and women, 50 years and older (51–92), low-income, and at average risk for CRC were recruited at an ambulatory care center in East Harlem. Assessments focused on sociodemographic, medical, psychosocial and TTM variables. The first logistic regression model showed that higher levels of education (p p p p p