Content uploaded by Wayne F Velicer
Author content
All content in this area was uploaded by Wayne F Velicer
Content may be subject to copyright.
The Transtheoretical Model of Health Behavior Change
Abstract
The transtheoretical model posits that health behavior change involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Ten processes of change have been identified for producing progress along with decisional balance, self-efficacy, and temptations. Basic research has generated a rule of thumb for at-risk populations: 40% in precontemplation, 40% in contemplation, and 20% in preparation. Across 12 health behaviors, consistent patterns have been found between the pros and cons of changing and the stages of change. Applied research has demonstrated dramatic improvements in recruitment, retention, and progress using stage-matched interventions and proactive recruitment procedures. The most promising outcomes to data have been found with computer-based individualized and interactive interventions. The most promising enhancement to the computer-based programs are personalized counselors. One of the most striking results to date for stage-matched programs is the similarity between participants reactively recruited who reached us for help and those proactively recruited who we reached out to help. If results with stage-matched interventions continue to be replicated, health promotion programs will be able to produce unprecedented impacts on entire at-risk populations.
... Given the limited research on adolescent willingness to enter a psychiatric residential program, we can turn to the Readiness to Change (RTC) literature for insight about this process. Originally proposed by Prochaska and Velicer (1997), the RTC framework describes five stages of patient readiness to change. Precontemplation is the initial stage, in which people do not plan to take action or see their behavior as a problem. ...
... In the absence of a formal readiness for change measure, we assessed treatment readiness at time of intake by using a single, multiple-choice, item which asked patients to "Please pick the response that best reflects how you felt about coming to [ Patients were then divided into three groups based on the first three stages of Prochaska and Velicer (1997) proposed stages of change. The first group is the treatment ready or preparation group, which are youths who endorsed response option (a). ...
... This has increased importance when considering early onset of these symptoms may lead to recurring depression through adulthood or later in life anxiety, substance use disorders, or suicidal behaviors (Fergusson & Woodward, 2002;Leone et al., 2020;Thapar et al., 2012). To address this question, we adopted the RTC model (Prochaska & Velicer, 1997) to assess its contribution to residential treatment outcomes. ...
There are many factors to consider when treating adolescents with psychiatric challenges, including whether they are willing and interested in participating in treatment. This study aimed to explore how treatment readiness impacts treatment experience for adolescents in psychiatric residential care who came into treatment with moderate to severe depression. All participants (N = 1,624; Mage = 15.58, SD = 1.46) were admitted to a large, multi-state psychiatric residential system between January 2020 and March 2022. Patients were 95.6% White, 99% non-Hispanic, and 64.7% identified as female. At intake, all patients were administered an assessment which includes the multi-dimensional Behavioral Health Screen (BHS) that assesses psychopathology and risk factors, a working alliance scale, depression, and well-being measures. Patients were also asked how they were admitted to the program, using a single item, multiple choice question as an informal treatment readiness measure, yielding three readiness groups: precontemplation, contemplation, or preparation. Regression analysis results indicated that patients’ readiness level was associated with different baseline characteristics (e.g., age, gender, psychopathology symptoms, risk factors) and week 3 outcomes (e.g., decreased symptoms, well-being, alliance, satisfaction). The clinical implications, as well as limitations and future directions, will be discussed.
... However, at the 2-week follow-up, those who set PA goals had significantly lower total MET-min at follow-up than those who did not set goals. Explanations for this finding using the transtheoretical model of behavior change is that those who set goals were possibly still in the contemplation or preparation stages of behavior change and action for behavior change had not yet occurred (Prochaska & Velicer, 1997;Marcus & Simkin, 1994). Because action on improving PA did not occur, MET-min at 2-week follow-up showed negative mediation with GH and EW outcomes. ...
The purpose of this study was to examine the associations of an online coaching intervention that included goal setting with movement behaviors and perceived general health (GH) and emotional wellbeing (EW) in college students. Participants were college students from a university within the western United States (N=257; 57.2% female). Participants met with health coaches in an online setting for one hour and goals were set for physical activity (PA) and/or sleep duration. PA, sleep duration, and perceptions of GH and EW were collected at baseline and at 2-and 4-weeks after the coaching session within a single arm research design. Mediation analyses determined the indirect effect (IE) of each movement behavior both after the health coaching session and after goal setting on the GH and EW outcomes in addition to the bidirectional association between GH and EW. No movement behavior positively mediated the associations with GH or EW after the health coaching session or after goal setting, although after goal setting PA and weeknight sleep at 2-weeks associated with GH at 4-weeks (b=0.16-0.39, p<0.01) and associated with EW at 4-weeks (b=0.22-0.25, p<0.01). EW mediated the associations of the health coaching session on GH (IE=0.19, p<0.001) and GH mediated the association of the health coaching session on emotional wellbeing (IE=0.09, p<0.001). In conclusion, movement behaviors correlated with GH and EW, but no positive mediating associations were observed. After the health coaching session, EW mediated the association with GH and vice-versa, suggesting a bidirectional association between the two health perceptions.
... I-change) which is the more integrated subsequent model of the ASE-model, which includes 5 different theories: the transtheoretical theory, theory of planned behavior, goal setting theory, health belief model, and social cognitive theory. (Ajzen, 1991;Bandura, 1986Bandura, , 2001Locke et al., 1981;Prochaska & Velicer, 1997;Rosenstock, 1974) Furthermore, the intervention employs motivational interviewing techniques, for which more research is still needed to prove its effectiveness. (Frost et al., 2018) Motivational interviewing can be used to support forming intentions and tools for self-e cacy and dealing with barriers. ...
Background
Working in healthcare often involves stressful situations and a high workload, and many healthcare workers experience burnout complaints or suffer from mental or physical problems. This also affects the overall quality of health care. Many previous workplace interventions focused on knowledge exchange instead of other health cognitions, and were not particularly effective. Multicomponent lifestyle interventions may offer the potential in improving lifestyle and well-being of healthcare professionals. This study aims to evaluate the impact of a multicomponent lifestyle intervention “Healthy & Vital” for healthcare professionals on several health-related outcomes.
Methods A pre- (multiple) post-pilot study has been conducted using data from 2012-2018 to evaluate the lifestyle intervention in 126 female healthcare professionals. Measurements were conducted before, directly after the intervention (at 3 months), and 6 months after finishing the intervention (at 9 months). Participants filled out questionnaires and anthropometrics measurements were conducted by a dietitian. The intervention is based on the ASE-model, theory of planned behavior, and motivational interviewing techniques. The intervention included workshops related to stress, eating, sleep, and individual meetings with a dietitian. Multilevel linear mixed models with a random intercept and fixed slope were used to evaluate the impact on lifestyle self-efficacy, eating behavior, anthropometric outcomes and quality of life.
Results Improvements were observed for lifestyle self-efficacy (total: beta=1.32 95%CI 0.94;1.48, I know: beta=1.19 95%CI 0.92;1.46, and I can: beta=1.46 95%CI 1.19;1.73), eating behavior (emotional eating: beta=-0.33 95%CI-0.44;-0.23, external eating: beta=-0.35 95%CI -0.44;-0.26, and diet/restrictive behavior: beta=0.41 95%CI 0.30;0.51), anthropometric outcomes (weight: beta=-5.03 95%CI -5.93;-4.12, BMI: beta=-1.873 95%CI -2.06;-1.41, waist circumference: beta=-6.83 95%CI -8.00;-5.65, and body fat percentage: beta=-1.80 95%CI -2.48;-1.17) and multiple outcomes of quality of life (physical functioning: beta=4.43 95%CI 1.98;6.88, vitality: beta=7.58 95%CI 4.74;10.42, pain: beta 4.59 95%CI 0.91;1.827, general health perception: beta=7.43 95%CI 4.79;10.07, and health change: beta=21.60 95%CI 16.41;28.80) directly after the intervention. The improvements remained after a six-month follow-up.
Conclusions Multicomponent interventions such as “Healthy and Vital” for healthcare professionals may be useful for improving the health of healthcare workers. More research using other designs with a control group, such as a stepped-wedge or RCT, is needed to verify our findings.
Trial registration: Retrospectively registered on May 1 2024 at the Open Science Framework Registries (https://doi.org/10.17605/OSF.IO/Z9VU5)
... These interventions that did not specify all techniques were in some cases described by the theoretical basis that guided the development of the intervention, such as the transtheoretical model (or 'stages of change'; Prochaska & Velicer, 1997), self-determination theory (SDT; Ryan & Deci, 2008), social cognitive theory (Bandura, 1986) and socio-ecological models (e.g. Contento, 2010;McLeroy et al., 1988). ...
Background
Behavior change interventions can unintendedly widen existing socio-economic health inequalities. Understanding why interventions are (in)effective among people with lower socio-economic position (SEP) is essential. Therefore, this scoping review aims to describe what is reported about the behavior change techniques (BCTs) applied within interventions and their effectiveness in encouraging physical activity and healthy eating, and reducing smoking and alcohol consumption according to SEP.
Methods
A systematic search was conducted in 12 electronic databases, and 151 studies meeting the eligibility criteria were included and coded for health behavioral outcomes, SEP-operationalization, BCTs (type and number) and effectiveness.
Results
Findings suggest that approaches for measuring, defining and substantiating lower SEP vary. Current studies of behavior change interventions for people of different SEP do not systematically identify BCTs, making systematic evaluation of BCT effectiveness impossible. The effectiveness of interventions is mainly evaluated by overall intervention outcomes and SEP-moderation effects are mostly not assessed.
Conclusion
Using different SEP-operationalizations and not specifying BCTs hampers systematic evidence accumulation regarding effective (combinations of) BCTs for the low SEP population. To learn which BCTs effectively improve health behaviors among people with lower SEP, future intervention developers should justify how SEP is operationalized and must systematically describe and examine BCTs.
Objective
Digital health interventions for behaviour change are usually complex interventions, and intervention developers should ‘articulate programme theory’, that is, they should offer detailed descriptions of individual intervention components and their proposed mechanisms of action. However, such detailed descriptions often remain lacking. The objective of this work was to provide a conceptual case study with an applied example of ‘articulating programme theory’ for a newly developed digital health intervention.
Methods
Intervention Mapping methodology was applied to arrive at a detailed description of programme theory for a newly developed digital health intervention that aims to support cardiac rehabilitation patients in establishing heart-healthy physical activity habits. Based on a Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) logic model of the problem, a logic model of change was developed. The proposed mechanisms of action were visualised in an acyclic behaviour change diagram.
Results
Programme theory for this digital health intervention includes 4 sub-behaviours of the main target behaviour (i.e. habitual heart-healthy physical activity), 8 personal determinants and 12 change objectives (i.e. changes needed at the determinant level to achieve the sub-behaviours). These are linked to 12 distinct features of the digital health intervention and 12 underlying behaviour change methods.
Conclusions
This case study offers a worked example of articulating programme theory for a digital health intervention using Intervention Mapping. Intervention developers and researchers may draw on this example to replicate the method, or to reflect on most suitable approaches for their own behaviour change interventions.
Background
Pedometer-based walking programs hold promise as a health promotion strategy for stroke prevention in community-dwelling older adults, particularly when targeted at physical activity-related modifiable risk factors. The question arises: What is the effectiveness of pedometer-based walking program interventions in improving modifiable stroke risk factors among community-dwelling older adults?
Method
Eight databases were searched up to December 2nd, 2023, following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Inclusion criteria focused on randomized controlled trials (RCTS) involving community-dwelling older adults and reported in English. Two independent reviewers utilized Physiotherapy Evidence Database (PEDro) tool to extract data, assess eligibility, evaluate study quality, and identify potential bias. Standardized mean difference (SMD) was employed as summary statistics for primary —physical activity level —and secondary outcomes related to cardiovascular function (blood pressure) and metabolic syndrome, including obesity (measured by body mass index and waist circumference), fasting blood sugar, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), and triglycerides. A random-effects model was used to generate summary estimates of effects.
Results
The review analyzed eight studies involving 1546 participants aged 60-85 years, with 1348 successfully completing the studies. Across these studies, pedometer-based walking programs were implemented 2-3 times per week, with sessions lasting 40-60 minutes, over a duration of 4-26 weeks. The risk of bias varied from high to moderate. Our narrative synthesis revealed positive trends in HDL-C levels, fasting blood sugar, and glycated hemoglobin, suggesting improved glycemic control and long-term blood sugar management. However, the impact on triglycerides was only marginal. Primary meta-analysis demonstrated significantly improved physical activity behavior (SMD=0.44,95%CI:0.26, 0.61,p=<0.00001;I²=0%;4 studies; 532 participants) and systolic blood pressure (SMD=-0.34,95%CI:-0.59,-0.09;p=<0.008;I²=65%,2 studies;249 participants), unlike diastolic blood pressure (SMD=0.13,95%CI:-0.13,-0.38,p=0.33; I²=91%; 2 studies; 237 participants). Interventions based on social cognitive, self-efficacy, and self-efficiency theory(ies), and social cognitive theory applied in an ecological framework, were linked to successful physical activity behavior outcomes.
Conclusion
Pedometer-based walking programs, utilizing interpersonal health behavior theory/ecological framework, enhance physical activity behavior and have antihypertensive effects in community-dwelling older adults. While they do not significantly affect diastolic blood pressure, these programs potentially serve as a primary stroke prevention strategy aligning with global health goals.
Trial registration
Registration Number: INPLASY202230118
The education and workforce sectors are adopting new strategies for apprenticeship programs. Innovative models have emerged that offer diverse opportunities for young people to develop skills and prepare for employment. This chapter focuses on Exalt Youth, a nonprofit organization that empowers young people who have been involved in the criminal justice system. Using narrative excerpts, we highlight how the program provides opportunities to overcome incarceration, integrate identity and lived experience, build community and engagement, and foster career pathways and professional networks. We provide recommendations for policymakers and practitioners to motivate and engage young people in creating meaningful pathways for professional, educational, and training opportunities that are both equitable and accessible.
Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
Two principles for progressing from the precontemplation stage of change to the action stage were discovered. The strong principle states that progression from precontemplation to action is a function of approximately a 1 standard deviation increase in the pros of a health behavior change. The weak principle states that progression from precontemplation to action is a function of approximately a 1/2 standard deviation decrease in the cons of a health behavior change. In Study 1, these principles were derived from cross-sectional data on 12 problem behaviors relating the pros and cons of changing to the stages of change. In Study 2, these principles were validated on cross-sectional data from an independent sample of 1,466 smokers. Discussion focuses on the implications of these principles for individual psychology and public health policy.
Investigated the generalization of the transtheoretical model across 12 problem behaviors. The cross-sectional comparisons involved relationships between 2 key constructs of the model, the stages of change and decisional balance. The behaviors studied were smoking cessation, quitting cocaine, weight control, high-fat diets, adolescent delinquent behaviors, safer sex, condom use, sunscreen use, radon gas exposure, exercise acquisition, mammography screening, and physicians' preventive practices with smokers. Clear commonalities were observed across the 12 areas, including both the internal structure of the measures and the pattern of changes in decisional balance across stages.
A meta-analysis was conducted of 125 studies on psychotherapy dropout. Mean dropout rate was 46.86%. Dropout rate was unrelated to most of the variables that were examined but differed significantly as a function of definition of dropout. Lower dropout rates occurred when dropout was defined by termination because of failure to attend a scheduled session than by either therapist judgment or number of sessions attended. Significant effect sizes were observed for 3 client demographic variables: racial status, education, and income. Dropout rates increased for African-American (and other minority), less-educated, and lower income groups. Recommendations for future psychotherapy dropout research are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Addresses the centrality of the self-efficacy mechanism (SEM) in human agency. SEM precepts influence thought patterns, actions, and emotional arousal. In causal tests, the higher the level of induced self-efficacy, the higher the performance accomplishments and the lower the emotional arousal. The different lines of research reviewed show that the SEM may have wide explanatory power. Perceived self-efficacy helps to account for such diverse phenomena as changes in coping behavior produced by different modes of influence, level of physiological stress reactions, self-regulation of refractory behavior, resignation and despondency to failure experiences, self-debilitating effects of proxy control and illusory inefficaciousness, achievement strivings, growth of intrinsic interest, and career pursuits. The influential role of perceived collective efficacy in social change and the social conditions conducive to development of collective inefficacy are analyzed. (21/2 p ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved). © 1982 American Psychological Association.
Cigarette smokers who quit on their own (n = 29) were compared with subjects from two commercial therapy programs: A version Group (n = 18) and Behavior Management Group (n = 16). Subjects were administered a Change-Process Questionnaire and a demographic and smoking-history questionnaire within seven weeks of successful cessation, then interviewed again in five months. Using a transtheoretical model of change developed by Prochaska (1979) six verbal and four behavioral processes of change and three stages of change (Decision to Change; Active Change; Maintenance) were analyzed. Subjects in each treatment group were middle class, heavy-smoking adults. The change-process analysis of cessation discriminated between the self-quitters and therapy quitters and between the two groups of therapy subjects on five variables. Stages of change interacted with the processes of change in the cessation of smoking behavior. Verbal processes were seen as important in making the decision to change while action processes were critical for breaking the actual smoking habit. Maintenance of cessation was related to, but not dependent on, how subjects actively changed smoking behavior.
How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key transtheoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages—pre-contemplation, contemplation, preparation, action, and maintenance—and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a transtheoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.
Objectives:
The primary hypothesis of COMMIT (Community Intervention Trial for Smoking Cessation) was that a community-level, multi-channel, 4-year intervention would increase quit rates among cigarette smokers, with heavy smokers (> or = 25 cigarettes per day) of priority.
Methods:
One community within each of 11 matched community pairs (10 in the United States, 1 in Canada) was randomly assigned to intervention. Endpoint cohorts totaling 10,019 heavy smokers and 10,328 light-to-moderate smokers were followed by telephone.
Results:
The mean heavy smoker quit rate (i.e., the fraction of cohort members who had achieved and maintained cessation at the end of the trial) was 0.180 for intervention communities versus 0.187 for comparison communities, a nonsignificant difference (one-sided P = .68 by permutation test; 90% test-based confidence interval (CI) for the difference = -0.031, 0.019). For light-to-moderate smokers, corresponding quit rates were 0.306 and 0.275; this difference was significant (P = .004; 90% CI = 0.014, 0.047). Smokers in intervention communities had greater perceived exposure to smoking control activities, which correlated with outcome only for light-to-moderate smokers.
Conclusions:
The impact of this community-based intervention on light-to-moderate smokers, although modest, has public health importance. This intervention did not increase quit rates of heavy smokers; reaching them may require new clinical programs and policy changes.
Presents a general descriptive theory of decision making under stress, which includes a typology of 5 distinctive patterns of coping behavior, including vigilance, hypervigilance, and defensive avoidance. The theory is illustrated with discussions of laboratory experiments, field studies, autobiographical and biographical material, and analyses of managerial and foreign policy decisions. Two analytical models, a schema for decision-making stages and a decisional "balance sheet," are also presented to clarify the theory. (28 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)