Do the Transtheoretical Processes of Change Predict Transitions in Stages of Change for Fruit Intake?

A feasibility study of a WhatsApp-delivered Transtheoretical Model-based intervention to promote healthy eating habits for firefighters in Hong Kong: a cluster randomized controlled trial

BACKGROUND

Firefighters' health is often affected by a high prevalence of obesity and cardiovascular diseases, which are common risk factors for sudden cardiac death. The aim of this study is to investigate the feasibility of enhancing healthy eating habits in firefighters through an education programme.

METHODS

This will be a cluster randomized control trial study. The participants will be assigned randomly into either control (health promotion pamphlet) or intervention (health promotion pamphlet and education materials through WhatsApp) groups. Changes in healthy eating habits will be assessed by a self-administered questionnaire and anthropometric measurements at three different time points.

DISCUSSION

More education is required in order to improve firefighters' eating habits.

TRIAL REGISTRATION

ISRCTN registry identifier: Registered on 8 April 2019 ISRCTN95472464.

The impact on adolescents of a Transtheoretical Model-based programme on fruit and vegetable consumption

OBJECTIVE

The present study aimed to evaluate the impact of a Transtheoretical Model-based programme titled 'Fruit & Vegetable-Friendly' on the fruit and vegetable (F&V) consumption of adolescents.

DESIGN

A quasi-experimental study. The 'Fruit & Vegetable-Friendly', a multicomponent intervention based on the Transtheoretical Model, was completed in eight weeks. The data were collected one week before the intervention, one week after the completion of the intervention and six months after the post-test with an F&V intake questionnaire and the stages of change, processes of change (α = 0·91), situational self-efficacy (α = 0·91) and decisional balance (α = 0·90 for pros, α = 0·87 for cons) scales. Data were analysed with the Friedman, Wilcoxon and marginal homogeneity tests.

SETTING

A public secondary school in Istanbul, Turkey.

PARTICIPANTS

Seven hundred and two adolescents.

RESULTS

The mean (sd) F&V intake of adolescents in the passive stages rose from the daily average at the time of the pre-test of 3·40 (1·79) portions to 5·45 (2·54) portions on the post-test and to 5·75 (2·70) portions on the follow-up test (P < 0·01). While the students in the passive stages represented 41·6 % of the participants prior to the programme, this rate fell to 23·7 % at the post-test and to 22·7 % at the follow-up. Students in the active stages first represented 58·5 % of the participants; this rate rose to 76·4 % at the post-test and to 77·2 % at the follow-up test.

CONCLUSIONS

The programme was effective in increasing the amount of F&V the adolescents consumed on a daily basis.

Stages of changes for fruit and vegetable intake and their relation to the nutritional status of undergraduate students

Objective:

To assess the nutritional and dietetic profile of freshman Nutrition undergraduate students, and its association with stages of changes (Transtheoretical Model) for fruit and vegetable intake.

Methods:

Demographic (age and gender), anthropometric (body mass index and waist circumference) and nutritional (pattern of fruit and vegetable intake) data were obtained. The Transtheoretical Model was used to identify the stages of change for fruit and vegetable intake. Food consumption was assessed with a questionnaire developed by the Ministry of Health. The significance level considered for all statistical tests was 0.05 (p<0.05).

Results:

From 433 eligible students, anthropometric measurements were taken from 219 (50.6%), and 299 (69%) underwent food intake evaluation. The sample included undergraduate students with a low frequency of adequate fruit and vegetables intake (29.8%), being the majority (64.9%) of them classified as at the preparation stage to increase the intake of these food groups. Prevalence of adequate fruit and vegetables intake was higher among students at the action/maintenance stages (83.3%) compared to those at the precontemplation/contemplation (18.3%) and at the preparation stages (32.0%). Students at the preparation stage presented the highest medians for body mass index (p=0.004) and waist circumference (p=0.039) compared to those at the precontemplation/contemplation stages. There was no association between fruit and vegetables intake and the presence of overweight or abdominal obesity (p=0.373).

Conclusion:

This instrument is effective to predict the food intake and, even among aware individuals and ready to change their food behavior, the prevalence of nutritional risk is high.

Positive and negative aspects of well-being as correlates of breast reconstruction decision

PURPOSE

The aim of the study was to explore the role of positive and negative aspects of well-being in a breast reconstruction decision, described in terms of the trans-theoretical model of change (TTM).

METHODS

The study comprised 216 women after total mastectomy in the cross-sectional design. The positive aspects of well-being were measured using the Rosenberg Self-Esteem Scale and Generalised Self-Efficacy Scale; the negative aspects were assessed using the Beck Depression Inventory and State-Trait Anxiety Inventory (T-Anxiety scale).

RESULTS

The multinomial logistic regression analyses were implemented, and the action stage was chosen as a relevant category. McFadden's pseudo R-squared for positive, negative and combined aspects of well-being models equalled 0.28, 0.13 and 0.27, respectively. For the first model, the differential effects were observed for well-being, age and relationship status (54 % correctly classified cases), whereas for the model with negative aspects-only age and well-being (44 % correctly classified cases). For a model combining two aspects of well-being, the pattern was similar to the one observed for positive well-being (53 % correctly classified cases). The likelihood of classifying women in the action stage rather than in the pre-contemplation stage was determined by three variables: being in a relationship, better well-being and younger age. For the contemplation stage, the same relations were obtained for well-being and age. Finally, for the preparation stage, the well-being effect disappeared.

CONCLUSION

The results suggest that positive rather than negative aspects of well-being, after control for sociodemographic variables, may be significant correlates of breast reconstruction decision.

Motivational interviewing within the different stages of change: an analysis of practice nurse-patient consultations aimed at promoting a healthier lifestyle

Combining the Stages of Change (SOC) model with Motivational Interviewing (MI) is seen as a helpful strategy for health care providers to guide patients in changing unhealthy lifestyle behaviour. SOC suggests that people are at different stages of motivational readiness for engaging in health behaviours and that intervention methods are most useful when tailored to a person's stage of change. However, it is unknown whether practice nurses (PNs) actually adapt their MI and more generic communication skills to a particular stage during real-life face-to-face consultations with their patients. The aim of this study was to explore whether and how PNs apply MI and general communication skills to the different SOC of patients, targeting behaviour change about smoking, alcohol use, dietary habits and/or physical activity. Real-life consultations between nineteen Dutch PNs and 103 patients were recorded on video between June 2010 and March 2011. All consultations focused on a discussion of patients' lifestyle behaviour. The Behaviour Change Counselling Index (BECCI) was used to code PNs' MI skills. Generic communication skills were rated with the MAAS-global. Patients' SOC was assessed for each consultation by observing the communication between patient and PN regarding the patient's current lifestyle behaviour. Multilevel analyses revealed that PNs adapt their MI skills to a patient's SOC to some extent. On average PNs apply MI skills more to patients in the preparation stage (P < 0.05) than during the other stages of change. PNs adjusted three MI skills and one generic communication skill to patients' SOC. This explorative study suggests that, at least to some extent, PNs intuitively assess the stage of patients' readiness to change and tailor their communication accordingly. However, differences between the stages were small. By teaching PNs to explicitly identify patients' SOC they could further enhance and adapt their MI and general communication skills to the individual.

Does the transtheoretical model of behavior change provide a useful basis for interventions to promote fruit and vegetable consumption?

PURPOSE

To determine whether Transtheoretical Model (TTM) constructs differ between individuals making successful versus unsuccessful stage transitions for consumption of five or more servings of fruit and vegetables each day and thus provide a useful basis for designing health promotion interventions.

DESIGN

Longitudinal, observational study. A randomly selected, multiethnic cohort of adults assessed at 6-month intervals over 2 years.

SETTING

General community, Hawaii.

SUBJECTS

There were 700 participants (62.6% female; mean = 47 ± 17.1 years; 31.1% Asian, 22.1% Native Hawaiian/Pacific Islander, 35.0% Caucasian; 25.1% participation rate).

MEASURES

Stage of readiness, experiential and behavioral processes of change, pros, cons, self-efficacy, and self-reported fruit and vegetable consumption.

ANALYSIS

The study used t-tests to determine which TTM variable scores differed consistently between those making "successful" versus "unsuccessful " stage transitions from precontemplation, preparation, and maintenance. Sample sizes for contemplation and action prohibited similar analyses.

RESULTS

Compared to those remaining in precontemplation, individuals successfully progressing from precontemplation showed significantly greater use of behavioral processes (collectively and self-liberation) and consciousness raising (p < .001). However, only self-liberation demonstrated significant differences consistently over time.

CONCLUSION

This longitudinal investigation reveals that TTM behavioral processes, particularly self-liberation, predict successful transition out of precontemplation for adult fruit and vegetable consumption, suggesting that public health messages tailored according to these TTM variables may be effective for this group. However, for adults prepared to adopt or maintain fruit and vegetable consumption, tailoring based on variables from other theories is needed.

Intra-family role expectations and reluctance to change identified as key barriers to expanding vegetable consumption patterns during interactive family-based program for Appalachian low-income food preparers

Few Americans eat sufficient vegetables, especially the protective deep orange and dark green vegetables. To address this, a community-based wellness program to broaden vegetables served at evening meals targeting Appalachian food preparers and their families was tested in a randomized, controlled intervention. Food preparers (n=50) were predominately married (88%), white (98%), and female (94%), with several children living at home. Experimental food preparers (n=25) attended the program sessions and controls (n=25) were mailed relevant handouts and recipes. At program sessions, participants received nutrition information, hands-on cooking instruction, and prepared recipes to take home for family evaluation. As qualitative assessment, 10 couples from each treatment group (n=20 couples) were randomly selected for baseline and immediate post-intervention interviews to explore impact on the food preparer's family. These in-depth interviews with the food preparer and their adult partner were tape-recorded and transcribed verbatim. Two researchers conducted thematic analysis using constant comparison. Family flexibility about food choices was assessed using roles, rules, and power concepts from Family Systems Theory. Interviews at baseline revealed dinner vegetable variety was very limited because food preparers served only what everyone liked (a role expectation) and deferred to male partner and children's narrow vegetable preferences (power). Control couples reported no change in vegetable dinner variety post-intervention. Most experimental couples reported in-home tasting and evaluation was worthwhile and somewhat broadened vegetables served at dinners. But the role expectation of serving only what everyone liked and the practice of honoring powerful family members' vegetable preferences remained major barriers to change.

Establishing the stages and processes of change for weight loss by consensus of experts

The present study aimed to establish, by a consensus of experts, the stages and processes of change for weight management in overweight and obese people. The first step involved developing two questionnaires aimed at assessing stages and processes of change for weight loss in overweight and obese people. The processes-of-change questionnaire consisted of 12 subscales, and contained 107 items. A three-round Delphi study was carried out through a website, where participants were asked to give their opinion about the representativeness and clarity of the scale items. The stages-of-change questionnaire consisted of five items and was presented in the final round of the study. A team of 66 experts in the obesity field from 29 countries participated in the study. They were selected either because they belonged to the organizing committee of international associations related to obesity, or because of their research career. The required changes in the questionnaire were made according to the opinions of the participants. Some of these were the result of the group statistical response, whereas others were due to the suggestions made by the participants. A final version of the questionnaire consisting of 63 items was eventually obtained. The present study produced two questionnaires to assess stages and processes of change for weight management. The strength of the study lies in the consensus reached by the panel of experts in order to establish the required content of the questionnaires. The two measures provide useful tools for practitioners who wish to tailor weight-management interventions according to transtheoretical model constructs.

Getting beyond outcomes: a realist approach to help understand the impact of a nutritional intervention during smoking cessation

OBJECTIVES

This paper discusses the benefits that a 'realist' approach can bring to an outcome study using the example of a nutritional intervention offered as an adjunct to the existing smoking cessation programmes to limit post-cessation weight gain.

SUBJECTS AND SETTING

Participants of a smoking cessation programme in areas of deprivation in the north, south and west of Glasgow.

RESULTS

A realist approach enabled the development of a framework able to investigate both implementation and outcomes of the intervention. Drawing on theoretical and experiential knowledge, context-mechanism-outcome hypotheses were developed for further testing at later stages of evaluation. This will focus the further stages of evaluation on testing these specific hypotheses using outcome data collected at the end of the intervention.

CONCLUSION

Adopting such an evaluation approach enables integration of process and outcome data that will refine our understanding of contexts and mechanisms, which are associated with these behavioural changes. It can aid further policy decisions by identifying the type of participant and circumstances that are associated with positive outcomes and those subgroups of participants that can be targeted more effectively using other approaches.