Disease management needs new paradigms.
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Clinical Trials as Topic↗
Biomedical subjects
J O Prochaska
Publications and source records attributed to J O Prochaska.
Validation of measures of condom and other contraceptive use among women at high risk for HIV infection and unintended pregnancy.
This study assessed the applicability of the transtheoretical model of behavior change (J.O. Prochaska & C.C. DiClemente, 1983, 1984) to the measurement of contraceptive use among 296 women at high risk for HIV infection and transmission. Structural equation modeling suggested that a measure of general contraceptive use could be used to assess use of oral contraceptives and hormonal implants but that measurement of condom use required separate assessments for main and other partners. Self-efficacy (SE) and decisional balance scales were internally consistent for general contraceptive use, for condom use with main partners, and for condom use with other partners. Consistent with research on other health behaviors, SE scores rose significantly across stages, from precontemplation to maintenance, and a shift in decisional balance was observed for 2 of 3 behaviors. This measurement strategy may enhance the ability to evaluate prevention programs for women at risk.
Adolescent↗
Contraceptive and condom use adoption and maintenance: a stage paradigm approach.
The Transtheoretical Model of Behavior Change was examined for its applicability to contraceptive and condom use adoption and maintenance using N = 248 heterosexually active college-age men and women. The model posits that individuals do not go directly from old behaviors to new behaviors to new behaviors, but progress through a sequence of stages: precontemplation, contemplation, preparation, action, and maintenance. The stages of change offer a temporal dimension that provides information regarding when a particular shift in attitudes, intentions, and behavior may occur. The model also postulates a set of or outcome variables--the pros and cons of change and self-efficacy. The results demonstrated that individuals were furthest along in the stages of change for general contraceptive use, followed closely by condom use with other (e.g., casual) partners, and then condom use with main partners. Although no sex differences were found for the stages for the three separate contraceptive behaviors, males and females differed on the pros and cons and levels of self-efficacy when engaging in intercourse with the two types of partners. MANOVA/ANOVA results indicated that the relationship between stages and other constructs follows predicted patterns suggesting that the transtheoretical model may provide a useful framework or paradigm for understanding contraceptive and condom use behavior.
Adolescent↗
Why do we behave the way we do?
Changing high risk behaviours involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance and termination. Stage-matched programs for cardiovascular disease prevention can produce much higher participation rates than traditional action-oriented programs (80 to 85% versus 1 to 5%). The amount of success following intervention is directly related to the state of change participants are in before intervention. Helping people progress through the stages involves matching particular processes and principles of change to particular stages of change.
Cardiovascular Diseases↗
A 2-year self-help smoking cessation manual intervention among middle-aged Finnish men: an application of the transtheoretical model.
BACKGROUND: A 2-year self-help manual smoking cessation intervention was conducted among a panel of middle-aged Finnish men (n = 265) who were recruited proactively in a longitudinal cardiovascular risk factor surveillance study. METHODS: Intervention utilized the stages of change concept of the transtheoretical model. The stages were assessed in the treatment condition at baseline of the cessation study and after that by mail every sixth month. Assessments were followed by an immediate mailing of a stage-based self-help manual matching the stage of change at that time. A usual care group was assessed annually but received no treatment. RESULTS: A significant time x intervention effect (P < 0.05) and time x baseline stage effect (P < 0.001) on quit rates were observed in the panel data over the 2-year period. An analysis of changes in the stages of change also revealed an accelerated cessation process in the treatment condition. CONCLUSIONS: We conclude that mailed stage-matched self-help smoking cessation manuals were able to accelerate the smoking cessation process but manuals alone may not constitute a sufficient long-term intervention. The effects of differential exposure to intervention, subject characteristics, measurement reactivity, and secular trends are discussed as potential confounds.
Adult↗
Psychosocial factors influencing low fruit and vegetable consumption.
A major national health campaign has recently been initiated to promote consumption of 5 or more servings of fruits and vegetables each day. This paper investigates psychosocial factors related to fruit and vegetable consumption to understand better who might be receptive and who might resist the national 5-A-Day campaign. We studied 405 adult respondents to a random-digit dial telephone survey. Applying the Transtheoretical Model, respondents were classified by stage of readiness to adopt the practice of eating 5 or more fruits and vegetables each day. Logistic regression models were developed for persons consuming 2 or fewer servings daily and for persons in the Precontemplation stage. Education was directly related to fruit and vegetable intake and indirectly related to being in the Precontemplation stage. Males were twice as likely as females to be in the Precontemplation stage and eat fewer than 2 servings a day. Of special interest, respondents with children at home were at greater risk of eating 2 or fewer servings a day than those without children at home (OR = 1.63; 95% CI, 1.06-2.52). These results imply that stage of readiness to change should be considered as well as other factors in planning interventions for increasing fruit and vegetable consumption.
Adult↗
Stages of change for reducing dietary fat to 30% of energy or less.
OBJECTIVE: To develop an algorithm that defines a person's stage of change for fat intake < or = 30% of energy. The Stages of Change Model describes when and how people change problem behaviors; change is defined as a dynamic variable with five discrete stages. DESIGN: A stage of change algorithm for determining dietary fat intake < or = 30% of energy was developed using one sample and was validated using a second sample. SUBJECTS: Sample 1 was a random sample of 614 adults who responded to mailed questionnaires. Sample 2 was a convenience sample of 130 faculty, staff, and graduate students. STATISTICS: Subjects in sample 1 were initially classified in a stage of change using an algorithm based on their behavior related to avoiding high-fat foods. Dietary markers were selected for a Behavioral algorithm using logistic regression analyses. Sensitivity, specificity, and predictive value of the Behavioral algorithm were determined, then compared between samples using the Z test. RESULTS: The following dietary markers predicted intake < or = 30% of fat (chi 2 = 131; P < .0001): low-fat cheese, breads without added fat, chicken without skin, low-calorie salad dressing, and vegetables for snacks. The specificity of the Behavioral algorithm was validated; the algorithm classified subjects consuming > 30% of energy from fat with 93% specificity in sample 1 and 87% in sample 2 (Z = 1.36; P > .05). Predictive value was also validated; 64% and 58% of subjects meeting the behavioral criteria had fat intakes < or = 30% of energy (Z = 1.1; P > .05). The algorithm was not sensitive, however; most subjects with fat intakes < or = 30% of energy from fat failed to meet the behavioral criteria. The sensitivity differed between samples 1 and 2 (44% and 27%, respectively; Z = 3.84; P < .0001). APPLICATIONS: The Behavioral algorithm determines stage of change for fat reduction to < or = 30% of energy in populations with high fat intakes. The algorithm could be used in dietary counseling to tailor interventions to a patient's stage of change.
Adult↗
Stages of change and decisional balance for 12 problem behaviors.
This integrative study investigated the generalization of the transtheoretical model across 12 problem behaviors. The cross-sectional comparisons involved relationships between two key constructs of the model, the stages of change and decisional balance. The behaviors studied were smoking cessation, quitting cocaine, weight control, high-fat diets, adolescent delinquent behaviors, safer sex, condom use, sunscreen use, radon gas exposure, exercise acquisition, mammography screening, and physicians' preventive practices with smokers. Clear commonalities were observed across the 12 areas, including both the internal structure of the measures and the pattern of changes in decisional balance across stages.
Adult↗
Strong and weak principles for progressing from precontemplation to action on the basis of twelve problem behaviors.
Two principles for progressing from the precontemplation stage of change to the action stage were discovered. The strong principle states that progression from precontemplation to action is a function of approximately a 1 standard deviation increase in the pros of a health behavior change. The weak principle states that progression from precontemplation to action is a function of approximately a 1/2 standard deviation decrease in the cons of a health behavior change. In Study 1, these principles were derived from cross-sectional data on 12 problem behaviors relating the pros and cons of changing to the stages of change. In Study 2, these principles were validated on cross-sectional data from an independent sample of 1,466 smokers. Discussion focuses on the implications of these principles for individual psychology and public health policy.
Algorithms↗
The transtheoretical model of change and HIV prevention: a review.
The transtheoretical model of health behavior change is described and supporting empirical work is presented that reviews the central constructs of the model: the stages of change, processes of change, decisional balance, confidence, and temptation. Model-based applications to a broad range of problem behaviors are summarized. Applications to human immunodeficiency virus (HIV) prevention behavior changes are highlighted for each variable. Finally, several questions about the area of sexual behavior change to reduce risk of HIV exposure are explored and future research ideas are described within the context of this model.
Attitude to Health↗
Processes of change in Alcoholics Anonymous: maintenance factors in long-term sobriety.
Examination of the change strategies associated with successful long-term sobriety remains an understudied area in addiction research. The following study recruited individuals in various stages of sobriety (range: 1 month to 27 years continuous abstinence). Subjects (N = 191) were surveyed on demographic, problem history, degree of self-help utilization, current process of change use and self-efficacy measures. Subjects were differentiated based on varying experience with AA, including exposure, frequency of meeting attendance and degree of affiliation. Analyses included comparisons on demographic, problem history, process of change and self-efficacy markers (i.e., self-change vs self-help; differing levels of self-help utilization). Few differences were found between groups on demographic or self-efficacy indices, although there was a trend for past or current AA attendees and medium affiliates to report slightly greater alcohol use prior to quitting compared to self-changers or low affiliates. There was a consistent, positive relationship between the use of behaviorally oriented change processes and increased involvement with AA, with current attendees and high affiliates utilizing these particular strategies more frequently than either self-changers, past attendees or the low to medium affiliate groups. The utility of process analyses in helping map the pattern of successful addictive behavior change is discussed.
Adult↗
A processes of change model for weight control for participants in community-based weight loss programs.
The processes of change model has been successful in predicting behavior change across a wide range of both addictive and nonaddictive problem behaviors. This study was designed to examine the application of the processes of change model to weight control. Study participants included 285 women and men enrolled in three community-based weight loss programs. Results based on structural equation analyses showed that the processes of change model fit the data better than several plausible alternative models. In addition, structural analyses revealed the existence of two general (higher order) processes of change for weight control, the experiential and behavioral processes. These results are similar to those previously reported for eight other problem behaviors. Limitations of the current work and future directions for this line of research are discussed.
Adolescent↗
Standardized, individualized, interactive, and personalized self-help programs for smoking cessation.
Smokers (N = 756) were randomly assigned by stage of change to (a) standardized self-help manuals (ALA+ condition), (b) individualized manuals matched to stage (TTT condition), (c) interactive expert-system computer reports plus individualized manuals (ITT condition), or (d) a personalized condition with 4 counselor calls, stage manuals, and computer reports (PITT condition). Over 18 months, the ITT group's results more than doubled those of the ALA+ group on abstinence measures. The ALA+ and TTT conditions were equivalent over 12 months, but at 18 months the TTT condition was more effective. The ITT condition was the best or comparable with the best treatment at all follow-ups for smokers at all stages of change. Results suggest that an effective expert system has been developed, and discussion focuses on delivering this system to entire populations of smokers.
Adult↗
Assessing the stages of change and decision-making for contraceptive use for the prevention of pregnancy, sexually transmitted diseases, and acquired immunodeficiency syndrome.
A synergistic approach was taken to examine contraceptive use adoption for two related behaviors: pregnancy prevention and the prevention of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). One hundred twenty-three young adults responded to questionnaire items based on two constructs from the Trans-theoretical Model of Change, the Stages of Change and Decisional Balance, as well as other pertinent variables. In Phase 1, two Decisional Balance measures were developed: One for the prevention of pregnancy and one for disease prevention. Final versions of both measures consisted of two 10-item scales: one representing the positive aspects (PROS) and one representing the negative aspects (CONS) of contraceptive and condom use. In Phase 2, the same individuals were staged for both pregnancy and disease prevention according to their readiness to change for contraceptive and condom use. MANOVAs and ANOVAs indicated that the PROS and CONS for both measures were related to stage of change for both contraceptive and condom use. Results from this pilot study were consistent with prior applications of the Trans-theoretical Model to the cessation of such problem behaviors as smoking and to the adoption of positive health behaviors such as exercise acquisition.
Acquired Immunodeficiency Syndrome↗
Working in harmony with how people quit smoking naturally.
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Humans↗
Attendance and outcome in a work site weight control program: processes and stages of change as process and predictor variables.
This naturalistic study assessed client changes during treatment and identified salient predictors of therapy attendance and outcome. Subjects were assessed on processes and stages of change, self-efficacy, social support, weight history (including expectations, goals, and reasons for losing weight), and demographics at the beginning, middle, and end of a 10-week, behaviorally oriented work site program for weight control. Significant shifts from contemplation to action occurred for clients remaining in treatment. There were also significant modifications in the use of change processes as a result of treatment: counterconditioning, contingency management, stimulus control, interpersonal control, and social liberation increased while medication use, wishful thinking, and minimizing threats decreased. Change processes employed during the early portion of the group treatment were the best predictors of treatment attendance and outcome, superior to self-efficacy, social support, weight history, and demographic variables. The results supported a transtheoretical model that emphasizes dynamic processes and stages as core dimensions for understanding how people change.
Adaptation, Psychological↗
Stages of change for smoking cessation among former problem drinkers: a cross-sectional analysis.
Recent research suggests that problem drinkers are less successful in quitting smoking. Stages of change, decisional balance, and self-efficacy measures were used to assess readiness for smoking cessation in a cross-sectional sample of former problem drinkers who were current smokers. As was expected, a very high percentage of recovering problem drinkers had been or currently were regular smokers. Distributions across the stages of change and relationships between stages and decisional balance in this problem drinker sample was found to be similar to results from more general smoking populations. Of those who had quit both smoking and alcohol, 62% quit drinking before or at the same time as smoking (53% before; 9% simultaneous). Those who quit drinking before or at the same time as smoking were characterized by a more problematic alcohol history. A stages-of-change perspective with this group is discussed, as are new avenues for future research with such populations.
Adult↗
Processes of change in smoking cessation: a cross-validation study in cardiac patients.
The processes of change associated with smoking cessation were examined for 213 smokers and recent exsmokers who were scheduled for cardiac catheterization and compared to the processes reported by a sample of 180 nonmedical smokers and exsmokers. Subjects were classified into one of three stages of change depending on their readiness to quit smoking: precontemplation, contemplation, and action. The cardiac sample employed the processes of change more frequently than the nonmedical sample in all stages, but the functional relationship between the stages and processes of change was generally similar for the two groups. The hierarchical structure of the processes of change also was similar for both groups. Differences between the two samples in the use of the processes of change are discussed. These results are the first to support the validity of the stages and processes-of-change model of smoking cessation in a population experiencing severe illness.
Adult↗