Using the Multi-Theory Model (MTM) of Health Behavior Change to Explain Intentional Outdoor Nature Contact Behavior among College Students

Utilization of the multi-theory model (MTM) of health behavior change to explain health behaviors: A systematic review

Background

The utilization of a theoretical framework is vital in health promotion research, particularly when endeavoring to modify health behaviors. This systematic review aimed at evaluating and synthesizing evidence through studies conducted using the fourth-generation multi-theory model (MTM) of health behavior change for its effectiveness.

Methods

A comprehensive article search was performed across MEDLINE, CINAHL, and Academic Search Premier. The search focused on studies utilizing MTM from 2016 to December 2023, following the PRISMA guidelines for systemic reviews.

Results

An initial pool of 7583 articles was narrowed down through screening of titles, abstracts, and full texts. A total of 69 articles met the inclusion criteria. These studies, encompassing a global range of diverse target groups and health behaviors, were categorized as qualitative, cross-sectional, or experimental. The six qualitative studies revealed MTM themes for diverse health behaviors. The fifty-six cross-sectional studies showed MTM constructs effectively predicting behavior change, albeit with varying statistical significance. The seven experiments demonstrated MTM's role in initiating and sustaining change. For the initiation model, operationalized by 49 studies, the mean adjusted R2 was 38.4% (SD=16.4%). For the sustenance model, operationalized by 45 studies, the mean adjusted R2 was 38.9% (SD=15.5%).

Conclusion

This systematic review corroborates the MTM as a potent framework for understanding, predicting, and facilitating health behavior changes. Its universal applicability and effectiveness underscore the model's potential as a foundational tool in designing future health promotion strategies and interventions aimed at positive and enduring behavior modifications.

Examining the Gambling Behavior of University Students: A Cross-Sectional Survey Applying the Multi-Theory Model (MTM) of Health Behavior Change in a Single Institution

Gambling among college students can start as a pastime activity. However, this pastime can lead to problem gambling and pathological gambling. This cross-sectional study aimed to identify and explain the initiation and sustenance of quitting gambling among university students who had participated in gambling during the past month and those who had not using a novel fourth-generation multi-theory model (MTM) of health behavior change. Data were collected from a sample of 1474 university students at a large southwestern university in the U.S. between January 2023 and February 2023, utilizing a validated 39-item survey. The statistical analyses employed in this study encompassed descriptive statistics, independent samples t-tests, and hierarchical regression modeling. Among students who had engaged in gambling in the past month, the constructs of participatory dialogue (β = 0.052; p < 0.05), behavioral confidence (β = 0.073; p < 0.0001), changes in the physical environment (β = 0.040; p = 0.0137), and demographic variables accounted for 27.7% of the variance in the likelihood of initiating the behavior change. Furthermore, the constructs of emotional transformation (β = 0.104; p = 0.0003) and practice for change (β = 0.060; p = 0.0368), and demographic variables accounted for 22.6% of the variance in the likelihood of sustaining quitting gambling behavior. The Multi-Theory Model (MTM) can be employed to design interventions aimed at reducing problem gambling among college students.

Exploring Yoga Behaviors among College Students Based on the Multi-Theory Model (MTM) of Health Behavior Change

During college years, perceived stress is the top reported hindrance to well-being and academic success. Data on the acceptance and perceived benefits of yoga among college students are limited. A purposive sample of college students (n = 79) from a course centered on Vinyasa Yoga and Mindfulness Meditation were recruited. Comprehensive yoga journaling data were collected, and a directed content analysis along the constructs of the multi-theory model (MTM) of health behavior change was utilized. The advantages of yoga that emerged were improved physical performance, reduced perceived stress, acceptance of oneself, better well-being, and improved coping. The identified disadvantages were time commitment, lack of motivation, and other competing interests. Learning through small steps, modifications, and identifying multiple sources of confidence helped build behavioral confidence. Practicing at home or at a yoga studio was a common theme for support in the physical environment. Directing negative emotions into purposes was helpful in maintaining the yoga practice. Sustained commitment to the practice also helped maintain the regular performance of yoga. Finally, social support from family, friends, and instructors was vital for continued practice. The study has important ramifications for the development of survey tools for descriptive studies and designing behavior-change yoga interventions in this target population.

Predicting Flossing through the Application of the Multi-Theory Model (MTM) of Health Behavior Change among Minority Adolescents in the United States

Adolescents from minority groups are particularly susceptible to poor oral hygiene behaviors, including lack of daily flossing. This cross-sectional study aimed to conduct an exploratory behavioral research to identify evidence-based (theory-based) approaches to promote flossing behavior among African American/Black and Latinx/Hispanic (minority) adolescents. A 39-item psychometrically valid web-based questionnaire was used to collect responses from a nationwide sample of minority adolescents aged 10-17 years residing in the United States. The data were analyzed using bivariate and multivariate statistical methods. Of 520 minority adolescents (260 African American/Black and 260 Latinx/Hispanic adolescents), the proportion of flossing was nearly equally split in the sample. A significantly higher proportion of minority adolescents who were flossing had access to floss as opposed to those who were not flossing (86.8% vs. 69.8%, p < 0.001). A significantly higher proportion of minority adolescents who were not flossing did not visit the dentist over the past year as opposed to those who floss (25.2% vs. 14.7%, p < 0.001). Among the participants who were not flossing, gender, grade level, instruction in school regarding flossing, and multi-theory model (MTM) of health behavior change constructs were the significant predictors (p < 0.001) of initiating and sustaining flossing. The findings of this study will serve as baseline data for developing and evaluating effective evidence-based interventions using the MTM.

Toward a Theory of Nature Experience and Health

This article presents an integrated theoretical framework to study the socioenvironmental attributes of the nature experience as a basic health behavior. After first reviewing existing literature on theories behind nature exposure, we discuss social cognitive theory (SCT) to explain individual nature experience through the model's triadic dynamic of environment, cognitions, and behaviors. We then expand beyond SCT's focus on the individual to examine structural and societal spheres of influence on nature experience found in ecological systems theory and ecosocial theory. In moving from proximal to distal influences, we identify the core constructs of each theory that may reinforce or deter decisions inclining individuals toward nature engagement. In synthesizing aspects of these three theories, we propose an integrated theoretical framework of nature experience distinguished by three ideas. First, individual-level formative influences in nature pervade higher level ecologies as a learned social behavior. Second, nature experience happens within multiple systems and timepoints. Third, social relationships within historical processes shape contextual factors of the nature experience, resulting in disparities in nature access and nature responses that manifest heterogeneously. Theorizing behind nature experience can inform why this occurs. We offer suggestions for further research to build on the groundwork put forth here: for hypothesizing around present observations, for collecting data to confirm and/or refute parts of the theory, and for further hypothesis generation inspired by the theory to inform the research agenda. In conclusion, we consider the practical implications of theory underlying nature experience as a health behavior relevant to research, interventions, and policy.

Assessing the Testability of the Multi-Theory Model (MTM) in Predicting Vaping Quitting Behavior among Young Adults in the United States: A Cross-Sectional Survey

PURPOSE

Given the increased exposure to e-cigarettes and nicotine among young adults, difficulty in quitting vaping is likely, which supports the need for effective behavioral interventions. Therefore, this cross-sectional study aims to assess the testability of the contemporary multi-theory model of health behavior change in predicting the vaping quitting behavior among young adults in the United States.

METHODS

A nationally representative sample of 619 young adults engaged in vaping behavior and aged 18-24 years was recruited to complete a 49-item web-based survey. A structural equation model was used to test relationships between MTM constructs. Hierarchical multiple regression was utilized to predict the variance in the initiation and sustenance of vaping quitting behavior by predictor variables, such as demographic characteristics, history of behaviors, and MTM constructs.

RESULTS

Of 619 respondents, over 75% were White and nearly 70% had educational attainment equal to high school or some college. In total, 62% of respondents were using nicotine, followed by 33.3% were using cannabis. About 80% of the respondents reported being engaged in drinking alcohol, and nearly 45% were engaged in cigarette smoking. The predictive effect of all MTM constructs on vaping quitting initiation (adjusted R2 = 0.417, F (23, 595) = 20.215, p < 0.001) and sustenance (adjusted R2 = 0.366, F (23, 595) = 16.533, p < 0.001) was statistically significant.

CONCLUSIONS

The findings of this study point to the usability and applicability of MTM in operationalizing and developing vaping quitting behavior interventions targeting young adults.

Using the Multi-Theory Model (MTM) of Health Behavior Change to Explain the Correlates of Mammography Screening among Asian American Women

Globally, breast cancer is the most common malignancy affecting women. The incidence of breast cancer has been growing among Asian American women. Mammography is a screening procedure that provides early diagnosis for the timely treatment to reduce premature mortality due to breast cancer. However, there are no national data available that summarize the rates of mammography screening among Asian American women. Some small-scale studies have reported low rates of mammography uptake among Asian American women. This cross-sectional study utilized the fourth-generation, multi-theory model (MTM) of health behavior change to explain the correlates of mammography screening among Asian American women between the ages of 45–54 years. A 44-item instrument was evaluated for face, content, and construct validity (using structural equation modeling) and reliability (Cronbach’s alpha) and administered electronically to a nationally representative sample of Asian American women (n = 374). The study found that Asian American women who have had received mammograms in the past 12 months as per recommendations, all three constructs of MTM, namely, participatory dialogue (β = 0.156, p < 0.05), behavioral confidence (β = 0.236, p < 0.001), and changes in the physical environment (β = 0.426, p < 0.001) were statistically significant and crucial in their decision to initiate getting a mammogram, accounting for a substantial 49.9% of the variance in the decision to seek mammography. The study also found that the MTM constructs of emotional transformation (β = 0.437, p < 0.001) and practice for change (β = 0.303, p < 0.001) were significant for maintaining the repeated behavior of getting annual mammograms and were responsible for 53.9% of the variance. This evidence-based study validates the use of MTM in designing and evaluating mammography screening promotion programs among Asian American women aged 45–54 years.

Conceptualization of college students' COVID-19 related mask-wearing behaviors using the Multi-Theory Model of health behavior change

Background: Recommendations and policies, regarding the use of face coverings, have been instituted to control transmission of coronavirus disease 2019 (COVID-19). Understanding of psychosocial factors related to the use of face coverings within the context of COVID-19 is needed. This study aimed to conceptualize mask-wearing behavior among students using the Multi-theory Model (MTM) of behavior change.

Methods: In October 2020, students (n = 595) enrolled in a large public southeastern US university were recruited to participate in a cross-sectional survey, using a valid and reliable instrument. Univariate, bivariate, and multivariate techniques described mask-wearing behavior and differentiated theoretical drivers of mask-wearing between individuals compliant and non-compliant with guidelines.

Results: Compliant individuals reported significantly higher scores (P <0.05) for initiation and sustenance of mask-wearing, participatory dialogue, behavioral confidence, emotional transformation, practice for change, changes in the social environment, and significantly lower scores for disadvantage. Among multivariable models, all theoretical predictors exhibited significant relationships to their respective outcomes (initiation and sustenance). Specifically, MTM constructs explained approximately 35% of variance in initiation (R² = 0.346, F_(3,526) = 94.32, P <0.001) and 33% of variance in sustenance of mask wearing (R² = 0.328, F_(3,529) = 87.71, P <0.001) for compliant individuals. Behavioral confidence and emotional transformation exhibited the strongest relationships to initiation (ß = 0.403, P <0.001) and sustenance (ß = 0.450, P <0.001), respectively.

Conclusion: Findings suggest a need to design educational programming based on the MTM to promote mask-wearing behavior among laggards who defy face mask guidelines, recommendations, and mandates.

COVID-19 Vaccine Acceptance among College Students: A Theory-Based Analysis

The severity and pervasiveness of the COVID-19 pandemic have necessitated the emergency use of COVID-19 vaccines. Three vaccines have been approved in the United States (USA). However, there is still some hesitancy in COVID-19 vaccine acceptability among some subgroups, including college students. While research is limited on vaccine acceptability behavior among college students, preliminary data suggests hesitancy as being high. This study aimed to explain the correlates of COVID-19 vaccine acceptance among college students who reported hesitancy toward the COVID-19 vaccine and those who did not using the initiation component of the multi-theory model (MTM) of health behavior change. Using a cross-sectional study design, data were collected from a Southern USA University (n = 282) utilizing a valid and reliable 27-item questionnaire in February and March 2021. Almost half (47.5%) of participants reported hesitancy to receive the COVID-19 vaccine. The three constructs of MTM’s initiation model, behavioral confidence (b = 0.089, p < 0.001), participatory dialogue (b = 0.056, p < 0.001), and changes in the physical environment (b = 0.066, p = 0.001) were significantly associated with COVID-19 vaccine acceptance among those who were not hesitant to take the vaccine and accounted for 54.8% of the variance. Among those who were hesitant to take the COVID-19 vaccine, the MTM construct of behavioral confidence (b = 0.022, p < 0.001) was significant along with Republican Party political affiliation (b = −0.464, p = 0.004), which was negatively associated with vaccine acceptance. The model accounted for 60.6% of the variance in intention to take the COVID-19 vaccine. This study provides evidence for the utility of MTM as a timely intervention to design messages for college students to enhance COVID-19 vaccine acceptability.

Explaining Handwashing Behavior in a Sample of College Students during COVID-19 Pandemic Using the Multi-Theory Model (MTM) of Health Behavior Change: A Single Institutional Cross-Sectional Survey

Amidst the COVID-19 pandemic, handwashing offers a simple and effective hygienic measure for disease prevention. Reportedly, a significant proportion of college students did not follow handwashing recommendations provided by the Centers for Disease Control and Prevention (CDC) in the pre-COVID era. The purpose of this cross-sectional study was to explore and explain the handwashing behavior among college students during the COVID-19 pandemic using a contemporary fourth-generation multi-theory model (MTM) of health behavior change. Data were collected from 713 college students at a large public university in the Southern U.S. in October 2020 using a validated 36-item survey. Statistical analyses included independent samples t-tests, Pearson correlation, and hierarchical regression modeling. Among students not following handwashing recommendations, the constructs of participatory dialogue (β = 0.152; p < 0.05) and behavioral confidence (β = 0.474; p < 0.0001) were statistically significant and accounted for 27.2% of the variance in the likelihood of initiation of the behavior. Additionally, the constructs of emotional transformation (β = 0.330; p < 0.0001), practice for change (β = 0.296; p < 0.0001), and changes in the social environment (β = 0.180; p < 0.05) were statistically significant and accounted for 45.1% of the variance in the likelihood of sustaining handwashing behavior. This study highlights the applicability and usability of the MTM in designing and testing behavior change interventions and media messaging in campaigns targeting college students.