Do processes of change predict smoking stage movements? A prospective analysis of the transtheoretical model.

The transtheoretical model (TTM) posits that processes of change and the pros and cons of smoking predict progressive movement through the stages of change. This study provides both a cross-sectional replication and a prospective test of this hypothesis. As part of a larger study of worksite cancer prevention (the Working Well Trial), employees of 26 manufacturing worksites completed a baseline and 2 annual follow-up surveys. Of the 63% of employees completing baseline surveys, 27.7% were smokers (N = 1,535), and a cohort of these smokers completed the 2-year follow-up. Cross-sectional results replicated previous studies with virtually all the processes of change and the cons of smoking increasing in linear fashion from precontemplation to preparation (all ps < .00001), and the pros of smoking decreasing (p < .01). However, contrary to the hypothesis, the baseline processes of change and the pros and cons of smoking failed to predict progressive stage movements at either the 1- or the 2-year follow-ups. Possible explanations for these findings and concerns about the conceptual internal consistency of the TTM are discussed.     

Cluster subtypes within the precontemplation stage of change for sun protection behavior

The aim of this study is to identify replicable cluster subtypes within the precontemplation stage of change for sun protection. Secondary data analysis of baseline data from a sample of participants in a home-based expert system intervention was performed. Three random samples were selected from participants in the precontemplation stage (N = 570). Cluster analyses were performed using the scales of pros, cons, and self-efficacy. Interpretability of pattern, pseudo F-test, and dendograms were used to determine the number of clusters. A four-cluster solution replicated across subsamples. Significant differences between clusters on the nine processes of change and on behavioral measures were found. Cluster solutions were robust, interpretable and with good initial external validity. They replicated patterns found for other behaviors, demonstrating long-term predictability and providing basis for tailored interventions.     

A 6-month investigation of exercise adoption from the contemplation stage of the transtheoretical model

Objectives: To investigate whether there are subtypes within the contemplation stage and to investigate whether self-efficacy and decisional balance changed in the manner predicted by the Transtheoretical Model (TTM) for individuals who adopted physical activity without intervention.Method: Participants were 118 adults (age range 18–66 years, MEAN=39.9 years) who were in contemplation at baseline. Participants completed two questionnaires assessing stage of exercise behaviour, self-efficacy and decisional balance 6 months apart.Results: Based on self-efficacy and pros and cons, three interpretable clusters were identified within the contemplation stage. Cluster membership influenced stage movement during the six months. Self-efficacy increased for those who adopted exercise and there was a significant increase in pros scores at 6 months for those who had recently adopted exercise.Conclusions: The existence of sub-stages indicates a true temporal order for the stages and has implications for closely tailoring interventions to the needs of the individual. Increasing self-efficacy and pros, and lowering cons is important in facilitating movement within the contemplation stage and from contemplation to action/maintenance.     

The pros and cons of temporally near and distant action

The present research demonstrated that in considering an action, considerations against (con) the action tend to be subordinate to considerations in favor of (pro) the action in that cons are considered only if the level of pros is sufficient, whereas pros are considered independent of the level of cons (Studies 1A and IB). The authors therefore concluded that pros constitute a higher construal level than cons and predict, on the basis of temporal construal processes (Y. Trope & N. Liberman. 2003). that pros would be more salient in making decisions for the more distant future, whereas the reverse should hold for cons. As predicted, participants generated more pros and fewer cons toward new exam procedures (Study 2), public policies (Study 3), and personal and interpersonal behaviors (Studies 4-6) that were expected to take place in the more distant future. This research also examined the limiting conditions and the evaluative consequences of these shifts.     

Examination of the Validity of a Stages of Exercise Change Algorithm

The purpose of this study was to examine the validity of a stages of exercise change questionnaire with self-reported exercise, age, and body mass index (BMI) in 1,034 male and female community residents. It was found that the maintenance stage participants reported more strenuous exercise than did individuals in the other stages; and participants in the action stage reported more strenuous exercise than did individuals in the preparation and contemplation stages. There were no significant group differences among participants in the preparation, contemplation, and precontemplation stages for strenuous and moderate exercise. The maintenance stage participants engaged in more moderate exercise than did the preparation, contemplation, and precontemplation individuals; and the action stage participants reported more moderate exercise than did individuals in the preparation and precontemplation stages. The participants in the maintenance stage were older than were those in the action stage. No significant stage differences were found for mild exercise or BMI. Knowing an individual's stage of exercise change may provide researchers and practitioners with a mechanism for developing, testing, and delivering stage-matched exercise interventions.     

Mediation analysis of decisional balance,sun avoidance and sunscreen use in the precontemplation and preparation stages for sun protection

Objective: Mediation analyses of sun protection were conducted testing structural equation models using longitudinal data with three waves. An effect was said to be mediated if the standardised path between processes of change, decisional balance and sun protection outcomes was significant.

Design: Longitudinal models of sun protection using data from individuals in the precontemplation (N = 964) and preparation (N = 463) stages who participated of an expert system intervention.

Main outcome measures: Nine processes of change for sun protection, decisional balance constructs of sun protection (pros and cons), sun avoidance behaviour and sunscreen use.

Results: With the exception of two processes in the preparation stage, processes of change predicted the pros (r = .126–.614), and the pros predicted the outcomes (r = .181–.272). Three models with the cons as mediator in the preparation stage, and none in the precontemplation stage, showed a mediated relationship between processes and outcomes.

Conclusion: In general, mediation analyses found both the process of change-to-pros and pros-to-behaviour paths significant for both precontemplation and preparation stages, and for both sun avoidance and sunscreen use outcomes. Findings provide support for the importance of assessing the role of underlying risk cognitions in improving sun protection adherence.     

Temporal distance and ease of retrieval

Construal Level Theory (CLT; Trope & Liberman, 2003) proposes that pro-arguments (pros) constitute high-level construals and counter-arguments (cons) low-level construals. Therefore, pros are more salient for distant-future actions than are cons and the reverse holds for near-future actions (Eyal, Liberman, Trope, & Walther, 2004). We further predicted and results from one experiment show that participants found it easier to generate pros if an action pertained to the distant rather than the near future. For cons the effect was reversed: participants found it more difficult to generate cons if the action pertained to the distant rather than the near future. Consequently, people were more in favor of the action if it pertained to the distant rather than the near future. Ease of retrieval mediated the effect of temporal distance on attitudes. The mutual relevance of the CLT framework and research on ease of retrieval is discussed.     

Psychosocial variables, external barriers, and stage of mammography adoption.

Guided by H. Triandis's (1980) 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=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.     

Sun protective behaviour,optimism bias,and the transtheoretical model of behaviour change

This study investigated the relationship between sun protective behaviours and three psychological variables influencing health behaviour: decisional balance, optimism bias, and the transtheoretical model of behaviour change. Two hundred participants completed the ‘Readiness to Alter Sun Protective Behaviour’ questionnaire, and a short questionnaire investigating optimism bias, decisional balance, attitudes, and experiences of sun protection and skin cancer. Participants were evenly distributed between the precontemplation, contemplation, and action stages. Participants in the action stage were significantly more likely to endorse the perceived advantages associated with sun protective behaviour than participants in the precontemplation and contemplation stages. They also reported sunbathing significantly less—and being more concerned about contracting skin cancer—than participants in the earlier stages. Decisional balance and optimism bias scores varied systematically across the stages of change; however, decisional balance was the only significant psychological predictor of sun protective behaviours. Optimism bias was greatest in the precontemplation stage, whereas the action stage was characterised by more positive attitudes to sun protection. This suggests that knowledge of the real risks of skin cancer might be a precursor to behaviour change, but only a change in attitudes results in a move to the action stage and measurable behaviour change.     

Does the transtheoretical model need an attitude adjustment?: Integrating attitude with decisional balance as predictors of stage of change for exercise

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.     

Predicting increases in readiness to quit smoking: A prospective analysis using the contemplation ladder

Abstract

Most smokers are not motivated to quit. The transtheoretical model posits mechanisms (processes of change and pros and cons) by which smokers might increase their stage of readiness to quit. While cross-sectional relationships among the stages of change, processes of change, and pros and cons are well established, there is little evidence that processes of change and pros and cons predict progressive stage movements. This study uses data from a large worksite-based cancer prevention study (the Working Well Trial) to test the hypothesis that processes of change and the pros and cons of smoking predict progressive movement up the contemplation ladder, which is an alternative measure of motivation to quit smoking based on social cognitive theory. The results indicate that experiential processes of change promote increases in readiness to quit smoking. This study provides further evidence for the predictive validity of the contemplation ladder and sheds light on how unmotivated, nonvolunteer smokers can be motivated to consider cessation.     

Perceived Pros and Cons of Condom Use as Predictors of its Consistent Use with a Heterosexual Romantic Partner Among Young Adults

The present research examines the pros and cons of condom use as predictors of consistent condom use with a heterosexual romantic partner. Data from 619 undergraduate students (35.1 % males; mean of age?=?20.31) were collected using a voluntary and anonymous self-report survey. The pros and cons predicted consistent condom use during the last month among females, whereas only the pros were predictive of consistent condom use in men. Similarly, only the feelings of safety predicted consistent condom use among men. However, the reduction of pleasure for women, the side-effects of other contraceptive methods, the difficulty in asking for condom use when they were also using the pill and the fact that condom use interrupts and cools off foreplay were also predictors among women. Besides the superiority of the pros over the cons, in general, the present research identifies a number of important pros and cons that should be used to encourage condom use.     

Group treatment for trichotillomania: behavior therapy versus supportive therapy

In this randomized controlled trial, group behavior therapy (BT; n = 12) was compared to group supportive therapy (ST; n = 12) in the treatment of trichotillomania (TTM). Both treatments were also compared to a naturally occurring waiting period, the time period that participants waited for groups to form. Participants completing group BT experienced significantly greater decreases in self-reported hair-pulling symptoms and clinician-rated hair loss severity than did those in group ST. Decreases were significantly greater after treatment than after the naturalistic waiting period. In addition, a significantly higher percentage of those in the BT than ST condition were rated as much improved or very much improved on the Clinical Global Impression scale at posttreatment. However, despite substantial symptom improvement, TTM severity remained problematic at posttreatment. Specifically, few participants in either treatment met criteria for clinically significant change at posttreatment. In addition, relapse of symptoms occurred over the 6-month follow-up period. Results provided partial support for the short-term efficacy of group BT. However, the group format may not maximize the efficacy of BT for TTM. Thus, it is recommended that future BT research test either individual therapy or a combination of group and individual formats for TTM.     

Postpartum return to smoking: staging a "suspended" behavior.

Two hundred fifty-six pregnant women who had quit smoking were classified into the precontemplation (PC), contemplation (C), preparation (PA), or action (A) stages of change for postpartum smoking cessation based on a 3-item algorithm assessing personal goals, self-efficacy, and smoking behavior. Logistic regression and event history analyses indicated group differences in return to smoking at 6 weeks and 3, 6, and 12 months postpartum. The percentage of women who returned to postpartum smoking was highest in the precontemplation stage and decreased with each subsequent stage, that is, at 6 weeks 83% of PCs, 64% of Cs, 35% of PAs, and 24% of As had returned to smoking. Results lend support for the stages of change for postpartum smoking abstinence. Stage-based interventions may be developed to assist women in maintaining abstinence postpartum.     

Self-efficacy,psychological adjustment and decisional-balance regarding decision making for outpatient chemotherapy in Japanese advanced lung cancer

This study examined the application of the trans-theoretical model (TTM) for readiness for decision-making of outpatient chemotherapy of Japanese advanced lung cancer patients by a cross sectional questionnaire survey. A questionnaire was conducted with 105 Japanese patients diagnosed with advanced lung cancer receiving chemotherapy. We classified them according to the TTM stages, including 4 in precontemplation, 42 in contemplation, 22 in preparation, and 35 in action. The valid model (χ ² (37) = 42.56, p = 0.24; GFI = 0.93; AGFI = 0.88; CFI = 0.98; RMSEA = 0.04; AIC = 100.56) derived from structural equation modeling (SEM) revealed that stage of outpatient chemotherapy was significantly affected mostly by decisional-balance (β = 0.60, p < 0.001) and partially by time from the patient's house to the hospital (β = ?0.15, p < 0.10), and that decisional-balance was significantly affected by self-efficacy (β = 0.48, p < 0.001) and nausea (β = ?0.23, p < 0.01). The findings from our study provided encouraging results for adopting the TTM in decision making for outpatient chemotherapy in Japanese cancer care and several clinical implications were obtained from the results.     

Mesure de la balance décisionnelle en vue de pratiquer une activité physique régulière (BDAP) : adaptation et validation francophone de l’échelle Decisional Balance for Exercise

ObjectiveThe purpose of this study was to validate a French version of the Decisional Balance Scale for Exercise (BDAP) and to examine its psychometric properties as well as its relationship with the three other components of Transtheoritical Model (TTM).Participants and methodFour hundred and six subjects (270 women), aged between 16 to 65 years old, fulfilled BDAP and other questionnaires measuring the three other components of TTM (Stages of Change of Exercise Behavior Scale, Exercise Processes of Change Questionnaire, Exercise Confidence Survey).ResultsConfirmatory factor analyses supported the two-factor model of BDAP (pros, α = 0.85 and cons, α = 0.73) assumed in the MTT. A good test–retest reliability was observed. BDAP was associated with the three other components of TTM.ConclusionThe French version of the BDAP shows good structural and psychometric properties. BDAP may be used as a valid tool in French-speaking populations.     

Understanding action control: predicting physical activity intention-behavior profiles across 6 months in a Canadian sample.

Intention is theorized as the proximal determinant of behavior in some theories of motivation, but the need to understand predictors of action control (i.e., translating an intention into behavior) is warranted to tailor physical activity intervention efforts. The purpose of this study was to examine constructs of the transtheoretical model of behavior change (TTM) as predictors of physical activity intention-behavior profiles across 6 months in a large Canadian sample (N = 1,192). Results showed that 5 of the 8 possible intention-behavior profiles had a substantial number of participants: nonintenders, unsuccessful adopters, successful adopters, unsuccessful maintainers, and successful maintainers. Constructs of the TTM distinguished (p < .01) intention-behavior profiles. Self-efficacy and the behavioral processes of change were particularly good predictors of action control (p < .01), but disaggregated beliefs and processes identified specific intervention targets for successful physical activity adoption and maintenance. The results validate that both action planning and action control are important when understanding physical activity behavior.     

Validation of scales measuring attitudes and norms related to mammography screening in women veterans.

Validation of psychosocial measures for use in mammography screening research has been given inadequate attention in the literature. The authors report on the validation of 5 measures examining 4 attitudinal constructs (i.e., pros, cons, outcome expectations, and cancer worries) and 1 social influence construct (i.e., subjective norms) in a 22-item inventory. The study participants consisted of a national, randomly sampled population of women veterans (n = 2,910). After minor revision of scales, the authors found independent measures for 4 constructs: pros, cons, cancer worries, and subjective norms. The authors concluded that these scales have acceptable psychometric properties; support construct validity; and provide brief, reliable, and valid measures of attitudes toward and norms regarding mammography screening. These scales may be useful for intervention research.     

The role of prior quitting experience in the prediction of smoking cessation

Aims: In the Transtheoretical Model (TTM), the preparation stage (as applied to smoking cessation) is defined as planning to quit in the next 30 days plus having quit for at least 24 h in the last year. This study examined the value of prior quitting experience as a stage classification criterion by investigating whether prediction of making a quit attempt differed as a function of prior quitting experience. Participants: One thousand and forty-six participants, all planning to quit in the next 30 days, in a randomised trial of the effectiveness of a telephone counselling and computer-generated tailored advice intervention were followed up at 3 months. Findings: A multivariate predictive model had markedly greater capacity to predict making a quit attempt among participants with prior quitting experience (as defined in several different ways), compared to analyses of the overall sample. A previous attempt of 24 h in the previous month was associated with the greatest difference in prediction. A quit attempt in the previous year (the TTM definition) did not discriminate. Conclusions: Recent prior quitting experience moderated the predictive capacity of some variables that influence smoking cessation. The findings provide some support for a stage model of smoking cessation but not its operationalisation by the TTM.