Insight into stage transition determinants is necessary to develop and evaluate stage-tailored health-promoting interventions. A three-round Delphi study among stages of change researchers was ...conducted to make an inventory of opinions and examine agreement on determinants of forward transitions between Transtheoretical stages of change. In the first round, 10 experts completed an electronic questionnaire with open-ended questions about potential determinants for each stage transition. In the second round, a structured electronic questionnaire based on the first round results was sent to authors of scientific papers on stages of change, published between 1995 and May 2002. In the third round, participants were presented feedback about the second round and were asked to re-rate their answers based on the information provided. Results showed that participants agreed on various transition determinants, but that determinants were not always stage-specific, e.g. control-related issues and social support were identified as determinants of all transitions from contemplation to maintenance. The results further showed lower consensus about determinants of earlier stage transitions than about determinants of later stage transitions. The Delphi study identified hypotheses worthy of further examination in longitudinal observational and experimental studies.
Studies that have investigated the effect of motivation to change on the startle reflex have been limited to comparisons among smokers with low and high motivation, but differences in the startle ...reflex throughout all stages of change have not been studied. Therefore, the aim of the present study was to identify differences in the startle reflex in response to tobacco-related cues in smokers in the initial, intermediate, and final stages of change. The startle reflex was recorded in 67 smokers and ex-smokers while they viewed pleasant, neutral, unpleasant, and tobacco-related pictures. The results showed that the pattern of the startle reflex in response to tobacco-related pictures varied according to the motivation to change. In smokers in the initial stages, the magnitude of the startle reflex was similar between tobacco-related pictures and pleasant pictures. In smokers in intermediate stages, the magnitude of the startle reflex was similar between tobacco-related pictures and unpleasant pictures. In ex-smokers in the final stages, the magnitude of the startle reflex was similar between tobacco-related pictures and neutral pictures. These results suggest that motivational systems that are activated by tobacco-related cues vary according to smokers’ motivation to change.
Domestic Violence (DV) remains a significant global health problem for women in contemporary society. Existing literature on midlife women's experiences of domestic violence is limited and focuses on ...health implications. Leaving a violent relationship is a dynamic process that often requires multiple attempts and separations prior to final termination. The aim of this study was to explore the process of leaving a violent relationship for midlife women.
This qualitative study involved fifteen women aged between 40-55 who had accessed residential and non-residential community support services for domestic violence within the UK. Community-based support agencies provided these women with access to letters of invitation and participant information sheet explaining the study. The women notified agency staff who contacted the research team to arrange a mutually convenient time to meet within a safe place for both the women and researchers. It was stressed to all potential participants that no identifiable information would be shared with the agency staff. Women were considered survivors of DV if they defined themselves as such. Data were gathered through semi structured interviews, transcribed verbatim and thematically analysed.
Midlife women appear to differ from younger women by transitioning quickly though the stages of change, moving rapidly through the breaking free onto the maintenance stage. This rapid transition is the resultant effect of living with long-term violence causing a shift in the women's perception towards the violent partner, with an associated reclamation of power from within the violent relationship. A realisation that rapid departure from the violence may be critical in terms of personal safety, and the realisation that there was something 'wrong' within the relationship, a 'day of dawning' that had not been apparent previously appears to positively affect the trajectory of leaving.
Midlife women appeared to navigate through the stages of change in a rapid linear process, forging ahead and exiting the relationship with certainty and without considering options. Whilst these findings appear to differ from younger women's process of leaving, further research is needed to explore and understand the optimum time for intervention and support to maximise midlife women's opportunities to escape an abusive partner, before being reflected appropriately in policy and practice.
Intervention. In an effort to increase physical activity, 15 workplaces participated in a minimal-contact 10,000-steps-a-day program sponsored by the Sedgwick County Health Department in 2007 and ...2008. Pedometers were provided to measure participants' weekly steps for the 10-week intervention. Method. Participants were defined as those who completed the preregistration survey and logged at least I week of results. Registrants were defined as those who completed a registration survey but did not log any weekly results. The primary dependent variable was whether or not participants achieved weekly success, as measured by achieving at least 70,000 steps in a week. A secondary dependent variable was participants' number of steps each week during the weeks they logged results. Repeated measures logistic regression analysis was conducted to identify factors associated with weekly success. Results. Of the 2,515 registrants, 1,292 (51%) were participants. The average number of weeks of participation for this 10-week intervention was 5.6 weeks (SD = 3.4). Those from small employers (n < 750) were more likely (OR = 2.0) than those from large organizations (n > 750) to become participants. Participants who achieved at least 70,000 steps in the first week of the intervention were 7.3 times more likely than participants who walked less than 70,000 steps in the first week to achieve 70,000 steps each week for all 10 weeks. Conclusions. Results from implementing a minimal-contact 10,000-step intervention can be maximized by targeting small worksites and supporting employees to achieve 70,000 steps in their first week.
Objective:
The expected emotional consequences of future actions are thought to play an important role in health behavior change. This research examined whether anticipated affective consequences of ...success and failure vary across stages of physical activity change and differentially predict physical activity adoption as compared to maintenance.
Design:
Using a prospective design over a 3-smonth period, a community sample of 329 healthy, middle-aged adults were assessed at 2 time points.
Main Outcome Measures:
Anticipated positive and negative emotions, stage of behavior change (precontemplation PC, contemplation C, preparation P, action A, maintenance M), and level of physical activity.
Results:
At baseline, anticipated positive emotions were greater in C versus PC, whereas anticipated negative emotions were greater in M versus A and in M versus P. Higher anticipated positive but not negative emotions predicted physical activity adoption and maintenance after 3 months.
Conclusion:
Although the expected affective consequences of future success and failure differentiated among individuals in the early and later stages of physical activity change, respectively; only the anticipated affective consequences of success predicted future behavior.
Application of behavior change theories to ethnically diverse groups is limited. In a secondary analysis of intervention study data, we tested the validity of the transtheoretical model (TTM) of ...change among Chinese American immigrant women. Three hundred mammography non-adherent women were randomized to an intervention or control group. Compared with contemplators (60%), precontemplators reported higher perceived mammography barriers (p < .001) and lower breast cancer susceptibility (p < .01). Baseline contemplators were 1.5 times more likely to have a mammogram post intervention compared with precontemplators. Upward shift in stage of change was higher in the intervention than the control group at 3 months (odds ratio OR = 6.14), 6 months (OR = 4.82), and 12 months (OR = 2.85). Women with an upward shift at 3 months were more likely to complete mammography at 12 months (OR = 15.44). The results supported the TTM stages of change. Education targeted to Chinese women’s stages of change has significant potential to decrease breast cancer screening disparities.
Purpose:
Previous studies found that treatment effects can change two behaviors, but not one. This study examined baseline transtheoretical model constructs as three alternative predictors (stage of ...change, effort, and severity) of singular action among participants with co-occurring health behavior risks.
Design:
The study examined participants at risk for three pairs of behaviors (sun and smoking; smoking and diet; and diet and sun). Analyses were conducted with participants who changed only one behavior in a pair (singular action).
Setting:
School and home-based behavior change programs recruited participants via schools, worksites, and physician practices. School, worksite, medical, and home-based prevention programs were the study setting.
Subjects:
The sample (N = 3213) was age 44.6 years (SD, 11.1 years), 94.6% white, and 63.7% female.
Measures:
Stages of change, effort, and severity variables were measured.
Analysis:
Pooled data were analyzed using logistic regressions from three randomized controlled trials.
Results:
Across all three behaviors, stage of change, effort, and severity effects were consistently related to behavior change at 24 months. Change efforts on one behavior were related to change on another behavior. Baseline sun severity (odds ratio, .97 .94, 1.00; p = .046) and smoking severity (odds ratio, .89 .80, .98; p = .019) were significant predictors of change on diet at final follow-up.
Conclusion:
Stage of change was the biggest predictor. Problem severity was the smallest predictor of change at 2-year follow-up. Four of six predictors were within behaviors, whereas two were between.
The aim was to estimate the prevalence of stages of change for physical activity and associated sociodemographic factors in students. The sample consisted of 942 students (44.7% males, 55.3% females; ...mean age = 16.1 years, SD = 1.1) in southern Brazil. Self-administered questionnaire was applied to identify stages of behavioral change for physical activity and sociodemographic variables (gender, age, maternal schooling, economic status, and school shift). Multinomial logistic regression was used to estimate the odds ratio (95%). Results showed that 9.6% were in the pre-contemplation stage, 18.4% in the contemplation, 17.6% in the preparation, 14.3% in the action, and 39.6% in the maintenance stages. Girls and adolescents with lower economic status were more likely to be at stages of behavioral risk. Students whose mothers had high education were more likely to be in the action stage.
Abstract Studies on psychoactive substance use in Nigeria had focused on prevalence and rarely on treatment implication(s) of large rates reported. Further challenge was to find suitable instruments ...to monitor change readiness as well as predict treatment outcomes along motivation continuum and according to resilience characteristics. Such ability will not only help to match treatment strategy with stage of change but also come with a more satisfactory outcome. This study therefore provided psychometric properties of one of such measuring scales: Stage of Change Readiness and Treatment Eagerness Scale version 8 (SOCRATES-8) and the accompanying change in resilience among Nigerians using psychoactive substances. Participants were 111 psychoactive substance dependent users in three treatment centers in Northern Nigeria. All respondents filled sociodemographic questionnaire, SOCRATES-8 and 14-item Resilience Scale. The study found overall motivation for change among participants to be medium on the three subscales of SOCRATES-8: ambivalence (median = 14.00; range = 7–20); recognition (median = 31.00; range = 7–35); and taking steps (median = 35.00; range = 12–40). More than half (61.3%) scored moderately on resilience. The Internal reliability of SOCRATES-8’s subscales fell into acceptable range (ambivalence = 0.54; recognition = 0.87; taking steps = 0.84). Pearson correlation coefficients of subscales with resilience are positive and in moderate range except for ambivalence with very low coefficient. Hierarchical cluster analysis based on participants’ resilience characteristics yields five distinct profiles corresponding to five stages of motivational change. ANOVA of these five profiles based on SOCRATES’ 3 subscales was significant. The study demonstrates utility of SOCRATES-8 to assess change readiness and treatment eagerness of psychoactive substance abusers according to stages of change and their resilience characteristics. This will aid treatment planning and can also measure treatment outcome.
In this article, we propose a qualitative approach to the study of the ways in which people face good and poor health issues. During the last 30 years, Prochaska and DiClemente's "trans-theoretical ...model" (1982, 1983, 1984, 1986, 1992) has gained relevance as a model to assess disposition for change in patients. We revise the features of the model and its common techniques to assess stages of change, underlining its methodological and conceptual problems. Particularly, we discuss the paradoxes set by "pre-contemplation" as a concept; the exogenous definition of human problems in terms of institutional and clinical criteria; and the ambiguity of the model, where the purpose of accompanying and orienting the patient contrasts with the imposition of problem definitions and solution strategies. We propose a narrative analysis of autobiographies of patients as an alternative that recasts their own notions of "change," "problem," and "vital trajectory." We illustrate this possibility with the analysis of an autobiographic interview with a woman who has a history of anorexia. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1203209
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