Longitudinal relationships among transtheoretical model constructs for smokers in the precontemplation and contemplation stages of change

Temporal Sequencing of Physical Activity Change Constructs within the Transtheoretical Model

OBJECTIVE

Studies support the Transtheoretical Model's (TTM) ability to describe behavior change processes and guide interventions; however, the temporal sequencing of constructs is less understood. This cohort study tested five sequences to identify TTM construct changes related to physical activity.

METHODS

A random sample provided baseline data (n=689; 63% female; M _age (SD)=47(17); 37% white), with 401 participants providing 24-month data, at six-month intervals.

RESULTS

Structural equation models revealed processes to cognitions to stage (AIC=29313.093, BIC=29514.883, CFI=0.999, RMSEA=0.006, SRMR=0.026); processes to stage to cognitions (AIC=27788.651, BIC=27973.268, CFI=0.978, RMSEA=0.024, SRMR=0.038), self-efficacy/temptations to processes to decisional balance to stage (AIC=13914.771, BIC=14031.169, CFI=0.981, RMSEA=0.018, SRMR=0.034), and stage to processes to cognitions (AIC=22048.324, BIC=22212.986, CFI=0.976, RMSEA=0.026, SRMR=0.029) all fit well. However, cognitions to processes to stage did not fit the data well (AIC=10353.555, BIC=10444.179, CFI=0.937, RMSEA=0.038, SRMR=0.035).

CONCLUSIONS

Integrating results revealed a cyclical model so that intervention efforts should focus on processes to change cognitions related to barrier self-efficacy and decisional balance, which then lead to change in stage and then renew focus on the processes.

Internists' views of maintenance of certification: a stages-of-change perspective

INTRODUCTION

Board certification has evolved from a "point-in-time" event to a process of periodic learning and reevaluation of medical competence through maintenance of certification (MOC). To better understand MOC participation, the transtheoretical model (TTM) was used to describe physicians' perceptions of MOC as a sequence of attitudinal changes.

METHOD

Data were from a survey of internal medicine (IM) physicians' attitudes toward periodic reevaluation through MOC. An overall importance or decisional balance score was computed for each physician by summing his or her ratings across the 10 quality measures. The decisional balance score was used to classify physicians according to their acceptance of MOC, aligned with the 3 early TTM stages-of-change groups-precontemplation (PC), contemplation (C), and preparation (P)-where PC was least accepting and P was most accepting. Effect sizes assessed whether differences in attitudes toward reevaluation via MOC were of sufficient magnitude to support the TTM principles.

RESULTS

The difference in degree of acceptance of MOC between the P group and the PC and C groups was significant (p < 0.001), but the effect size was lower than predicted by the "strong" principle. Resistance to MOC for the PC and C groups was significantly greater than the P group (p < 0.001) and supported the "weak" principle. Physicians' beliefs about how often they should demonstrate performance on quality measures aligned well with the American Board of Internal Medicine's MOC requirements, with the P group believing in more frequent assessments than the PC and C groups (p < 0.001).

CONCLUSIONS

Results show that physicians in the Preparation stage had overcome resistance to MOC as predicted by the "weak" principle of the TTM, but their attitude scores about the benefits of MOC were below what was expected by theory. This suggests that the structure of MOC may have made it easier for physicians to overcome barriers to MOC participation but may have lacked adequate resources to promote the benefits of participating in the process. More effort is needed to understand the specific benefits of MOC for reevaluating competencies, how to engage physicians and other stakeholders in the design of MOC, and how to communicate the rationale and evidence to those who are less accepting of MOC.

Construct validity and invariance of four factors associated with colorectal cancer screening across gender, race, and prior screening

Understanding individuals' perceptions of colorectal cancer screening (CRCS) is important for developing effective interventions to increase adherence to screening guidelines. Theory-based cognitive and psychosocial constructs have been associated with CRCS in the literature, but few studies have evaluated the psychometric properties of such measures. We hypothesized a correlated four-factor model, including CRCS perceived pros, cons, social influence, and self-efficacy. We also examined measurement invariance across subgroups based on gender, race (white; African American), and prior CRCS experience (never; overdue for repeat screening). We used baseline (n = 1,250) and 2-week (n = 1,036) follow-up survey data from participants in a behavioral intervention trial designed to increase CRCS. Only minor modifications were made to the hypothesized model to improve fit, and the final model was confirmed with a random half of the sample, as well as with follow-up data. Results support the hypothesized unidimensional construct measures and suggest that the items may be appropriate for all subgroups examined. Greater variance in responses to items assessing the perceived cons of CRCS was found among African Americans compared with whites, suggesting that race may moderate the association between perceived cons and CRCS in this sample. Pros, cons, social influence, and self-efficacy are associated with CRCS; therefore, using scales with known psychometric properties strengthens researchers' ability to draw conclusions about group differences and changes over time and to compare their results with other studies. Replication studies in other populations are needed to provide further evidence of construct validity for the scales reported here.