Promoting exercise behavior among Chinese youth with hearing loss: a randomized controlled trial based on the transtheoretical model

The transtheoretical model proposes that behavior change is experienced as a series of stages. Interventions tailored to these stages are most likely to be effective in progressing people through the model's hypothesized behavior change continuum. In this study, a stage-tailored, 12-week, exercise behavior intervention based on the transtheoretical model was conducted among a sample of 150 Chinese youth with hearing loss. Participants were randomized into an intervention or control group with all the core transtheoretical model constructs assessed pre- and post-intervention. Participants in the intervention group showed greater advances in their stage of exercise behavior change, decisional balance, and processes of change use compared to those in the control group. The intervention, however, was insufficient for increasing participants' self-efficacy for exercise behavior. The findings partially support the utility of the theory-based intervention for improving the exercise behavior of Chinese youth with hearing loss, while simultaneously helping to identify areas in need of improvement for future applications.     

The adaptive change model: an advance on the transtheoretical model of change

The author proposed a hypothetical model of change, the adaptive change model (ACM), to advance the current conceptualization and operationalization of the transtheoretical model of change (TTM; D. Grimley, J. Prochaska, W. Velicer, M. Blais, & C. DiClemente, 1994; J. Prochaska, 1979; J. Prochaska & C. DiClemente, 1984). He used exploratory factor analysis to identify items contributing to 2 sets of factors defining the Adaptive Change Questionnaire (T. Bowles, 2001). The factors were consistent for both clinical (n = 222) and nonclinical (n = 194) respondents. The first set of factors defined the process of change and included Openness to Opportunity, Visualization, Planning, Action, and Closure. The second set of factors described the factors that support change and included Social Support, Inner Drive, and Negative Emotions. Through analysis of gender effects, the author found that men scored significantly and slightly higher than did women on Openness to Opportunity, Visualization, and Inner Drive. There were no interactions involving gender and clinical status. Discriminant function analysis predicting clinical status on the basis of the 8 factors placed 80% of respondents in the correct category. The author discusses the relevance of the ACM in comparison with the characteristics of the TTM.     

The contributions of Rosenbaum's model of self-control and the transtheoretical model to the understanding of exercise behavior

ObjectivesRosenbaum's [1990. The role of learned resourcefulness in the self-control of health behavior. In M. Rosenbaum (Ed.), Learned resourcefulness: On coping skills, self-control, and adaptive behavior (pp. 3–30). New York: Springer Publishing Company; 2000. The self-regulation of experience: openness and construction. In P. Dewe, A. M. Leiter, &; T. Cox (Eds.), Coping and health in organizations (pp. 51–67). London: Taylor and Francis] model of self-control depicts learned resourcefulness as a key component of the goal attainment process. Despite this model's popularity, few studies have examined its importance in the maintenance of exercise. The transtheoretical model of change has been used instead. The two models, nonetheless, share strikingly similar components with the exception of learned resourcefulness.Design/MethodsOur 265 participants, ranging from wanting to be active to being regular exercisers, completed instruments assessing learned resourcefulness, stage of change for exercise, self-efficacy, reasons for exercising and the processes of change for exercise.ResultsAs predicted, participants in the maintenance stage for exercise were on average more highly resourceful than participants in the contemplation, preparation and action stages of change. Low resourceful participants in the contemplation stage of change were the least likely to be employing strategies to help facilitate activity.ConclusionImplications for exercise promoters are discussed.     

Conscientiousness, the transtheoretical model of change, and exercise: a neo-socioanalytic integration of trait and social-cognitive frameworks in the prediction of behavior

ABSTRACT Relationships between conscientiousness-related traits and transtheoretical model (TTM) of change constructs, exercise self-efficacy, and exercise behavior were examined in college and community samples ( N =566). Measures of the conscientiousness-related traits of conventionality and industriousness were expected to show positive relations with measures of exercise behavior stage location, processes of exercise behavior change, endorsing the benefits of exercise behavior (i.e., decisional balance), exercise self-efficacy, and self-reported exercise behavior. In addition, based on Neo-Socioanalytic Theory ( Roberts & Wood, 2006 ) an intervening role was predicted for TTM constructs and exercise self-efficacy in the relationship between conscientiousness-related traits and exercise behavior stage location. The results showed industriousness (being hardworking) to be the most robust conscientiousness-related predictor of stage location, processes of change, endorsing the benefits of exercise behavior, and exercise self-efficacy. Mediation analyses showed the relationship between industriousness and exercise behavior stage location to be fully accounted for by select processes of change and exercise self-efficacy scales. The results are discussed in terms of a useful integration of trait and social-cognitive approaches to exercise behavior, with an emphasis on the role of industriousness as an important individual difference factor therein.     

The transtheoretical model of change: Examples from stammering

Procaska and DiClemente's model of intentional change was initially associated with the field of addiction but has been more recently used in the treatment of a broad range of difficulties. Examples in this article come mainly from therapy with adults who stammer. The model explores how people initiate and maintain change and is based on empirical evidence. It comprises 3 dimensions. Ten processes describe the ‘how' of change. Five levels outline the ‘what' of change, arranged hierarchically from sympom/situational to intrapersonal conflicts level. The five stages of change, the ‘when' of change are described here in some detail, together with ideas for the most suitable therapeutic approaches to be used at each.     

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.     

Exploring the retirement from sport decision-making process based on the transtheoretical model

ObjectivesThe purpose of this study was to complement and extend the current knowledge of the particular stages of athletes’ career transition process through employing the transtheoretical model (Prochaska & DiClemente, 1984) as a theoretical framework. More specifically, the current study aimed to explore Korean elite tennis players’ career transition process through focusing on their retirement decision-making process, including their cognitive and behavioral changes and internal and external influences for their decisions during the final stages of their sport careers and the retirement decision-making process.DesignWe employed focus groups.MethodsA total of 12 participants took part in one of three focus groups (i.e., four current players, five retired players, and three coaches) that focused on the process of athletes' retirement decision-making. All participants (seven males and five females; Mean age = 31.25, SD = 3.49 years) were either current or former Korean elite-level tennis players. The data were thematically content analyzed.ResultsThe results revealed three themes: (a) readiness for retirement, (b) psychological and emotional responses during the decision-making process, and (c) coping strategies; and showed that athletes’ decision-making at the end of their sports careers is a dynamic process, accompanied by various emotional responses requiring different coping strategies at different stages.ConclusionFindings indicated that the transtheoretical model helped to explain athletes’ decision-making in retiring from sport and suggested to the need to provide different interventions at different stages. Identifying detailed aspects of readiness for retirement and examining the effectiveness of interventions grounded in the transtheoretical model are recommended as future research directions.     

The relationship among the transtheoretical model of behavioral change,psychological distress,and diet attitudes in obesity: Implications for primary care intervention

Obesity is prevalent but undertreated in primary care. Family practice volunteer outpatients (N=454) were administered the Stage of Change for Weight (URICA), the Brief Symptom Inventory (BSI), and the Diet Readiness Test (DRT) to assess the relationship between these variables and obesity. The body mass index (BMI) was used to classify obesity revealing 197 patients with elevated BMI's. There was no significant difference between the obese and the nonobese on any of the psychological measures. The obese reported significantly more difficulty setting diet goals and less control over their eating, ate more to emotional situations, and exercised less than the nonobese. The obese sample (46.7%) reported being in the Action stage of change for weight management. Implications for intervention in primary care include targeting attitudes (DRT) and dispelling physician attitudes that obese individuals have increased levels of psychological distress. Addressing Stage of Change for weight management can facilitate tailoring the appropriate intervention when used in concert with the DRT variables.     

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.     

A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention.

Stress has been associated with a variety of chronic and acute conditions and with higher use of health care services. This research reports on 18-month outcomes of a randomized clinical trial of a stress-management program based on the transtheoretical model (TTM; J. O. Prochaska & C. C. DiClemente, 1986). A national sample of 1,085 individuals participated (age range = 18-91 years, M = 55.33; 68.9% female, 31.1% male; 84.8% Caucasian; 15.2% non-Caucasian). Both the treatment and control groups received assessments at 0, 6, 12, and 18 months. In addition to the assessments, the treatment group received 3 individualized reports (0, 3, 6 months) and a manual. The 18-month assessment was completed by 778 individuals (72%). A random effects model indicated that participants completing the study in the treatment group had significantly more individuals reporting effective stress management at follow-up time points than did completers in the control group. Results also indicate that the intervention had significant effects on stress, depression, and specific stress-management behaviors. Results provide evidence for the effectiveness of this TTM population-based stress-management intervention.     

Nonlinear change processes and the emergence of suicidal behavior: A conceptual model based on the fluid vulnerability theory of suicide

Although ideation-to-action theories of suicide aim to explain the emergence of suicidal behaviors, researchers have primarily focused on the content of underlying mechanisms (i.e., who dies by suicide). Much less attention has focused on the temporal dynamics of suicide risk (i.e., when suicide occurs). The fluid vulnerability theory conceptualizes suicide as an inherently dynamic construct that follows a nonlinear time course. Newer research implicates the existence of multiple nonlinear change processes among suicidal individuals, some of which appear to be associated with the emergence of suicidal behavior. The cusp catastrophe model provides a useful model for conceptualizing these change processes and provides a foundation for explaining a number of poorly understood phenomena including sudden emergence of suicidal behavior without prior suicidal planning. The implications of temporal dynamics for suicide-focused theory, practice, and research are discussed.     

Stage of exercise change model and attitudes toward exercise in older adults.

This study examined the attitudes toward exercise held by older adults within different stages of the exercise change model for the purpose of aiding health professionals in developing effective approaches that engage older adults in physical activity. Men and women (n = 116) between the ages of 60 and 93 years (73.9+/-6.6) completed a questionnaire used to categorize them into one of five stages of exercise change: precontemplation, contemplation, preparation, action, and maintenance. Participants also completed a questionnaire to assess four attitude factors related to exercise: tension release, health promotion, vigorous exercise, and social benefits. The Active older adults in this study reported positive attitudes toward exer cising for health benefits, social interaction, and tension release. Of these, the health benefits of exercise appear to be the most important factor in their participation in exercise. Therefore, prograns designed to engage older adults in regular physical activity should promote positive attitudes toward exercise, especially regarding the health related aspects of exercise.     

Information-motivation-behavioral skills model-based HIV risk behavior change intervention for inner-city high school youth.

This study assessed the effects of 3 theoretically grounded, school-based HIV prevention interventions on inner-city minority high school students' levels of HIV prevention information, motivation, behavioral skills, and behavior. It involved a quasi-experimental controlled trial comparing classroom-based, peer-based, and combined classroom- and peer-based HIV prevention interventions with a standard-of-care control condition in 4 urban high schools (N = 1,532, primarily 9th-grade students). At 12 months postintervention, the classroom-based intervention resulted in sustained changes in HIV prevention behavior. This article discusses why both of the interventions involving peers were less effective than the classroom-based intervention at the 12-month follow-up and, more generally, suggests a set of possible limiting conditions for the efficacy of peer-based interventions.     

A service learning based intervention to change attitudes toward obese individuals in kinesiology pre-professionals

The purpose of this study was to conduct an intervention to change attitudes toward obese individuals. Ninety-five Kinesiology undergraduates conducted a FITNESSGRAM service-learning project with school-aged children. They completed anti-fat attitude test (AFAT) and explicit attitude assessments before and after the intervention. The results indicated participants had anti-fat bias toward obese individuals on the lazy/motivated scale, but not on the other four scales on pre measurements. Their anti-fat attitudes concerning whether people are responsible for their weight were significantly reduced through the intervention. Five themes emerged from the undergraduates’ reflective papers that support the efficacy of the intervention: Healthy lifestyle—an individual choice, barriers to physical activity, multi-factorial nature of obesity, and promotion of physical activity through information and encouragement. The findings partially support experiential learning as a potential mechanism to reduce individuals’ anti-fat attitudes.

A neurophysiologic model for aggressive behavior in the cat

A neurophysiologic model for aggessive behavior in the cat is proposed. Stimulus-bound and seizure-bound aggression was evaluated in relation to limbic and basal ganglia induced seizures (after-discharges). Electrically induced limbic and basal ganglia afterdischarges were used because they are known to implicate septohypothalamic sites from which aggression can be elicited by direct stimulation. The occurrence of behavioral aggression is correlated with the discharge characteristics of a single discharging system and with two interacting discharging systems. Aggression is composed of autonomic and somato-motor components which poses relatively low and high thresholds, respectively, for their activation. Aggression occurring during a combined septum and amygdala discharge was more intense and prolonged than with a septum discharge alone. Participation of a slow frequency discharging basal ganglia system activated seizurebound aggression in an otherwise nonaggressive limbic seizure. The limbic and basal ganglia stimulations and after-discharges lowered the excitability threshold of the aggression system and made it more vulnerable to being activated by external stimuli, such as visual and auditory stimuli. These observations are reminiscent of patients with aggressive behavior associated with psychomotor seizures.     

A motivational model for environmentally responsible behavior

This paper presents a study examining whether self-efficacy and intrinsic motivation are related to environmentally responsible behavior (ERB). The study analysed past environmental behavior, self-regulatory mechanisms (self-efficacy, satisfaction, goals), and intrinsic and extrinsic motivation in relation to ERBs in a sample of 156 university students. Results show that all the motivational variables studied are linked to ERB. The effects of self-efficacy on ERB are mediated by the intrinsic motivation responses of the participants. A theoretical model was created by means of path analysis, revealing the power of motivational variables to predict ERB. Structural equation modeling was used to test and fit the research model. The role of motivational variables is discussed with a view to creating adequate learning contexts and experiences to generate interest and new sensations in which self-efficacy and affective reactions play an important role.     

A response time model for choice behavior

A subject in a two-choice situation characteristically makes several observing responses before performing the final choice. This behavior can be described by means of a random walk model. The present paper explores some possibilities as to how this model can be extended to include choice time. The assumption is made that the duration of each step in the random walk is a random variable which is exponentially distributed. With this assumption, one can predict the probability distributions of the choice times as well as the moments of these distributions.The author gratefully acknowledges his debt to W. K. Estes and C. J. Burke. This study was initiated while the author held a USPHS postdoctoral fellowship at Indiana University.