Moving beyond the transtheoretical model

Facilitating behavior change: Introducing the Transtheoretical Model of Behavior Change as a conservation psychology framework and tool for practitioners

The primary opportunities for improved conservation and sustainability outcomes are through changing human behavior. Zoos, aquariums, and other public-facing biodiversity conservation institutions offer an important space for environmental learning and facilitating proenvironmental behavior change. We have focused, in this review, on examining common behavior change models as well as the Transtheoretical Model (TTM) of Behavior Change​​​​​, a widely regarded model within the health fields and, recently, in the fields of environmental and leadership studies, with new research applying the TTM specifically in a zoo setting. We have discussed critiques of the TTM and rebuttals to those critiques. We have presented examples of TTM applications in a zoo setting. Our objective has been to explore the TTM as a possible "best fit" framework and tool for zoo and aquarium practitioners in facilitating proenvironmental behavior. Key findings include that (a) the TTM differs significantly from other proenvironmental behavior theoretical models, including those that are prevalent in the conservation psychology literature and applied by zoos and aquariums, in terms of the TTM stages of change and processes of change constructs; (b) the TTM appears to overlap significantly with the 10 interventions or treatments identified by researchers as the most effective approaches to facilitating proenvironmental behavior; and (c) there is nascent and promising application of TTM constructs in zoo and aquarium programming. We remain impressed by the potential of the TTM to address a critical question within the conservation psychology research field concerning proenvironmental behavior: what specific tools to employ and when.

The Dietary Behaviors of Participants in UK-Based Meat Reduction and Vegan Campaigns - A Longitudinal, Mixed-Methods Study

Meat reduction, vegetarianism, and veganism have greatly increased in popularity during the 21st century, particularly in the United Kingdom. Yet, little is known about the process of reducing or abstaining. Through the use of focus groups and a longitudinal, web-based survey delivered over a twelve-month period, this project provides insights into the reported dietary habits and trends of participants in UK-based meat reduction and vegan campaigns (n = 1539). Drawing on Michie, Atkins, and West (2014)'s Behavior Change Wheel to better understand the process of dietary transition, findings reveal key opportunities for policymakers and non-profit organizations to better understand and support the process of dietary change. Reported planned dietary changes suggest a tendency for gradual transitions, with planned and achieved changes generally reflecting proposed reduction and abstention hierarchies. Planned reductions were most likely to include red meat and least likely to include seafood or eggs, while seafood abstention was more common than that of dairy or eggs. Those seeking to abstain from the consumption of some or all animal-derived foods were the most likely to report meeting their anticipated dietary changes, while meat reducers were generally unlikely to indicate that they were achieving planned reductions.

A Preliminary Study Examining Women's Physical Health and Nonmedical Prescription Opioid Use in a Recovering Framework

BACKGROUND

There is a growing need for research on women recovering from nonmedical prescription opioid use. A paradigm shift is to focus on wellness and factors that support, rather than hinder, recovering women. For example, although physical health is impacted by nonmedical prescription opioid use, improved health may be a strength-based factor among recovering women. The aim of this preliminary study was to examine physical health in a recovering framework as women begin recovering from nonmedical prescription opiate use.

MATERIALS AND METHODS

This study conducted secondary data analysis using self-report data from Kentucky's Targeted Assessment Program (TAP). TAP assesses and provides pretreatment for problems impeding work or interfering with parental responsibilities. Data included 1247 adult women reporting a history of nonmedical prescription opioid use and receiving pretreatment. Bivariate and logistic regression analyses examined whether physical health and access to health services at baseline were associated with substance-related behavior change upon completion of pretreatment.

RESULTS

Women reporting better physical health and fewer days with no activities due to health barriers were more likely to engage in pretreatment substance-related behavior change [χ²₍₈₎ = 34.6, p < 0.05]. However, ∼40% of women reported barriers in accessing healthcare.

CONCLUSION

Using a recovering framework, women's physical health, as expected, is associated with engagement in pretreatment substance-related behavior change. Ongoing service coordination with practitioners and medical providers should be incorporated into care to meet the need. Future research should continue to examine factors that support recovering women, using a recovering framework.

Effectiveness of advice from physician and nurse on smoking cessation stage in Taiwanese male smokers attending a community-based integrated screening program

BACKGROUND

A screening program provides a teachable moment for primary prevention such as encouraging smoking cessation. However, little is known about the efficacy of smoking cessation intervention delivered to the general population through a community-based screening program.

METHODS

A quasi-experimental untreated control design with pre-test and post-test was conducted with 42 subjects receiving advice from physician and nurses (the PNA group), 39 receiving an informational leaflet (the leaflet group), and 308 control subjects.

RESULTS

The overall rate of reaching the action stage was 25 %, 5.7 %, and 7.8 in the PNA group, the leaflet group, and the control group, respectively. In approximately 45-60 % of all participants, the stage remained unchanged. Such an association between the intervention groups and stage changes was statistically significant (p = 0.02). The PNA group was more likely to have the improvement of stage (forward transition toward action stage) than the control group [adjusted odds ratio (aOR) = 2.27 (1.07-4.84)]. Deterioration (backward transition toward precontemplation) in the PNA intervention group was 37 % lower than that in the control group [aOR = 0.63 (0.20-2.01)].

CONCLUSIONS

This study demonstrated that smoking cessation advice from physician and nurse is conducive to smoking cessation, as shown by greater movement toward and less movement away from smoking cessation through a community-based integrated screening platform.

Motivating Factors and Psychosocial Barriers to Condom Use among out-of-School Youths in Dar es Salaam, Tanzania: A Cross Sectional Survey Using the Health Belief Model

Condoms remain a cost-effective and relatively simple intervention to prevent HIV infection. However, condom use is still very low, particularly among youths aged 15 to 24. 348 individuals (186 males and 162 females) completed a pre-tested questionnaire. Logistic regression analysis was used to identify factors associated with condom use. Out of 348 respondents, 296 (85.0%) were sexually experienced, and 260 (87.8%) reported noncondom use in the past 3 months prior to the study. Among men, noncondom use was independently associated with feeling shy to buy condoms (AOR = 1.16; 95% CI 1.12–1.34), condoms reducing sexual pleasure (AOR = 8.19; 95% CI 3.98–17.01), and HIV is a serious and deadly disease (AOR = 0.36; 95% CI 0.28–0.46). Among women, experiencing forced sex (AOR = 1.16; 95% CI 1.10–2.78), condoms reduce sexual pleasure (AOR = 8.29; 95% CI 3.36–20.73), and inability to convince a partner to use condoms (AOR = 1.14; 95% CI 1.04–1.28) were predictors of noncondom use. In conclusion, sexually active youths in this population practice risky sexual behaviours, with low condom use practices. Strategies to improve condom use should address these psychosocial barriers associated with noncondom use.

Walking to wellness in an ageing sedentary university community: design, method and protocol

BACKGROUND

Older workers are less physically active and have a higher rate and cost of injury than younger workers and so have reduced work-ability. Concurrently, sedentary behaviour in the workplace, in transport and in the home is increasing and has harmful health effects. Walking is a familiar, convenient, and free form of health-enhancing physical activity that can be integrated into working life and sustained into older age however workplace walking programs targeted at older workers have not been evaluated.

PURPOSE

We designed a randomised-controlled trial to evaluate the impact of a phased individually-tailored 10-week walking program on work-day steps, health status and work-ability of employees at an Australian university with an ageing sedentary workforce.

METHODS

A convenience sample of 154 academic and administrative employees aged 45-70 years will be recruited and randomly allocated to either an experimental (walking) group or control (maintain usual activity) group. Participants will be provided with a pedometer and complete measures for step count, % body fat, waist circumference, blood pressure, self-reported physical activity, psychological wellbeing and work-ability, at baseline and end-intervention. 'Walkers' will select approaches tailored to their individual preference, psychological characteristics or life circumstances. Two distinct intervention phases will target adoption (weeks 2-5) and adherence (weeks 7-12) using 'Stages of Behaviour Change' principles. An ANOVA will test for effect of treatment on outcome with the baseline value entered as a covariate.

DISCUSSION

This study will test whether tailoring worksite walking is an effective means of promoting health-enhancing physical activity in ageing sedentary workers.

Research on integrative healthcare: context and priorities

It is important that integrative healthcare research be conducted to optimize the effectiveness, safety, costs, and social and economic impact of prospective, personalized, patient-centered, comprehensive, and holistic healthcare that focuses on well-being as well as disease management, and that the research itself be well understood. The scope of this research extends beyond evaluation of specific therapies, to include evaluations of multimodality whole system intervention, practitioner-patient relationships, patient goals and priorities, promoting self-care and resilience, personalized diagnostic and therapeutic measures, practitioner well-being, the comparative effectiveness of different educational and outreach strategies in improving health and healthcare, and the environmental/social causes and consequence of health and healthcare. In this paper, we describe the state of the science of research on integrative healthcare, research needs, and opportunities offered by cutting-edge research tools. We propose a framework for setting priorities in integrative health research, list areas for discussion, and pose a few questions on a future research agenda.

Psychosocial factors and substance use in high-risk youth living with HIV: a multi-site study

The purpose of the study was to test relationships between psychosocial factors and alcohol and illicit drug use among high-risk youth living with HIV (YLH). One hundred eighty-six high-risk youth with HIV (defined as those with a substance use problem, sexual risk problem, or medication adherence problem) were enrolled across five cities (ages 16-24). Alcohol and illicit drug use were measured with the alcohol, smoking, and substance involvement screening test and a timeline follow-back interview. Questionnaires assessed constructs from the adapted Transtheoretical Model (TTM) including a continuous measure of motivational readiness in response to criticisms of the stage component. Path analysis was utilized to fit cross-sectional data collected via computer assisted personal interviewing (baseline data from intervention study). Separate models were fit for each commonly used substance. In the previous month, 47% used alcohol, 37% used cannabis, and 9% used other illicit drugs. Path models fit the data well and accounted for 30% of the variance in alcohol use and 47% in cannabis use. Higher self-efficacy predicted lower alcohol and cannabis use, but motivational readiness was only directly related to cannabis use. A reduction in pros of substance use was indirectly related to use. Social support and psychological distress were associated with TTM constructs. Interventions focusing on improving motivation and self-efficacy for healthy behaviors may reduce substance use in YLH.

Predictors of condom use in a multisite study of high-risk youth living with HIV

Young people between the ages of 13 to 24 are at persistent risk for HIV infection in the United States (Centers for Disease Control and Prevention [CDC], 2006). Young adulthood is a period characterized by experimentation, including engagement in risky behaviors (e.g., substance use and sexual behavior) (Moore & Parsons, 2000). Most young adults are sexually active, with the highest rates of sexual activity reported among youth of color (Park, Mulye, Adams, Brindis, & Irwin, 2006). The prevalence of sexually transmitted infections (STIs), especially chlamydia and gonorrhea, peak in young adulthood and are highest among youth of color (CDC, 2003).

Predictive validity and measurement issues in documenting quit intentions in population surveillance studies

INTRODUCTION

Discrete classification of smokers by intention to quit is desirable in many public health and clinical settings.

METHODS

Two methodological studies examine measurement properties of measures of discrete-time intention to quit smoking used in population-based tobacco surveillance surveys: an ecological comparison of rates of positive intention in relation to the form of measure used and a prospective analysis examining predictive validity of self-reported quit intentions using multiple possible points of dichotomization of an ordinal measure of intention to quit. The prospective analysis used a repeated measures design and follow-up to 1 year for 2,047 smokers in the Ontario Tobacco Survey cohort.

RESULTS

The estimated percent of smokers intending to quit was significantly higher using the Stages of Change intention measure, relative to another single question measure. Significant dose-response effects were found. The sooner one intended to quit the more likely one was to make an attempt or achieve at least 30 days abstinence in the next 6 months. Intending to quit in a month or later was not associated with cessation during follow-up among respondents without prior attempts. Examination of cutpoints revealed no value, which maximized both positive and negative prediction. Regardless of quit attempt history, greatest predictive validity was found where respondents stated that they had no intention at all.

DISCUSSION

Measures of intentions quit smoking in specific time periods and expressed as dichotomies have limited psychometric properties but utility in applied research. Our findings suggest a possible measurement effect warranting caution in comparisons across studies.

Nutritious food intake: a new competitive advantage for organizations?

Purpose

The purpose of this paper is to suggest that nutritious food intake is a somewhat overlooked yet essential aspect of corporate wellness that has the potential to help provide organizations with a sustainable competitive advantage.

Design/methodology/approach

The paper first discusses the resource‐based view, identifying ways in which nutritious food intake across an organization may serve to create rare and inimitable organizational resources leading to a competitive advantage. It then presents a basic overview of the fundamentals of nutritious food intake. It proceeds to review the transtheoretical stages of change model in the context of tailored nutrition interventions in organizations, providing a detailed overview of key individual behavior focused and environmental focused change strategies along with a discussion of types of technical delivery systems.

Findings

The paper suggests that an organization may be able to use a tailored stage‐based nutrition intervention as part of a comprehensive wellness program in order to help create a sustainable competitive advantage based on the nutritious food intake of its members.

Research limitations/implications

Future researchers should continue to examine the effectiveness of stage‐based computer tailored nutrition interventions and their delivery systems, particularly in the context of comprehensive corporate wellness plans and the extent to which this serves to create a competitive advantage through lower direct healthcare costs and higher worker productivity.

Practical implications

Organizational leaders should carefully consider the strategies and methodologies presented in this paper when designing and implementing nutrition interventions as part of a broad corporate wellness program.

Originality/value

This paper makes a valuable contribution to the organizational literature by recognizing the potential for the application of the transtheoretical stages of change model from the field of nutrition education within the context of the resource‐based view of organizations.

Modeling attitude towards drug treament: the role of internal motivation, external pressure, and dramatic relief

Motivation for change has historically been viewed as the crucial element affecting responsiveness to drug treatment. Various external pressures, such as legal coercion, may engender motivation in an individual previously resistant to change. Dramatic relief may be the change process that is most salient as individuals internalize such external pressures. Results of structural equation modeling on data from 465 drug users (58.9% male; 21.3% Black, 34.2% Hispanic/Latino, and 35.1% White) entering drug treatment indicated that internal motivation and external pressure significantly and positively predicted dramatic relief and that dramatic relief significantly predicted attitudes towards drug treatment: chi (2) = 142.20, df = 100, p < 0.01; Robust Comparative Fit Index = 0.97, Root Mean Squared Error of Approximation = 0.03. These results indicate that when external pressure and internal motivation are high, dramatic relief is also likely to be high. When dramatic relief is high, attitudes towards drug treatment are likely to be positive. The findings indicate that interventions to get individuals into drug treatment should include processes that promote Dramatic Relief. Implications for addictions health services are discussed.

The barriers to smoking cessation in Swiss methadone and buprenorphine-maintained patients

Background

Smoking rates in methadone-maintained patients are almost three times higher than in the general population and remain elevated and stable. Due to the various negative health effects of smoking, nicotine dependence contributes to the high mortality in this patient group. The purpose of the current study was to investigate Swiss methadone and buprenorphine-maintained patients' willingness to stop smoking and to clarify further smoking cessation procedures.

Methods

Substance abuse history, nicotine dependence, and readiness to stop smoking were assessed in a sample of 103 opiate-dependent patients in the metropolitan area of Zurich, Switzerland. Patients were asked to document their smoking patterns and readiness to quit.

Results

Only a small number of patients were willing to quit smoking cigarettes (10.7%) and, even though bupropione or nicotine replacement therapy was included in the fixed daily treatment care, only one patient received nicotine replacement therapy for smoking cessation. A diagnosis of depression in patients' clinical records was associated with readiness to stop smoking. No significant associations were found between readiness to quit smoking and age, methadone treatment characteristics, and presence of co-dependencies.

Conclusion

The current prescription level of best medicine for nicotine dependence in Swiss methadone and buprenorphine-maintained patients is far from adequate. Possible explanations and treatment-relevant implications are discussed.

Donation intentions among African American college students: decisional balance and self-efficacy measures

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.