Madelynne A. Arden

Exploring discontinuity patterns in the transtheoretical model: An application of the theory of planned behaviour.

OBJECTIVES: The principal objective of the present paper was to investigate the utility of an extended theory of planned behaviour (TPB) for discriminating between stages of the transtheoretical model (TTM). DESIGN: Congruent with Sutton (2000) a cross-sectional design was employed. The study (N = 331) investigated the TPB and TTM in the domain of health-related food choice. METHOD: The study utilized a questionnaire methodology. The data were analysed using analyses of variance and polynomial contrast analyses. RESULTS: Results showed a significant linear trend for all TPB variables across TTM stages, although there were significant quadratic relationships between TTM stage and both subjective norm and behavioural intention. Hierarchical regression analyses indicated that TTM stage might best be regarded as a proxy measure of behaviour. CONCLUSIONS: The present study provides evidence to support the utility of the TPB but casts doubt on the TTM. Further research is required to evaluate the effectiveness of interventions targeted at individuals in certain stages with variables informed by the TPB, and to extend the present findings beyond the domain of health-related food choice.

Stages of change or changes of stage? Predicting transitions in transtheoretical model stages in relation to healthy food choice.

Relatively little research has examined factors that account for transitions between transtheoretical model (TTM) stages of change. The present study (N = 787) used sociodemographic, TTM, and theory of planned behavior (TPB) variables, as well as theory-driven interventions to predict changes in stage. Longitudinal analyses revealed that sociodemographic, TPB, and 1 of the interventions predicted transitions between most stages of change. In fact, only progression from the preparation stage was not predictable. However, given that this change of stage marks the transition between cognition and actual behavior, the identification of variables that bridge this gap is crucial for the development of interventions to promote stage transitions.

How useful are the stages of change for targeting interventions? randomized test of a brief intervention to reduce smoking

OBJECTIVE To see whether the stages of change are useful for targeting a brief intervention to reduce smoking based on implementation intentions. A second objective was to rule out demand characteristics as an alternative explanation for the findings of intervention studies based on the transtheoretical model and implementation intentions. DESIGN Participants (N = 350) were randomized to a passive control condition (questionnaire only), active control condition (questionnaire plus instruction to plan to quit), or experimental condition (questionnaire, plan to quit, form an implementation intention). Their behavior and psychosocial orientation to quit were measured at baseline and at 2-month follow-up. MAIN OUTCOME MEASURES Theory of planned behavior variables, nicotine dependence, and quitting. RESULTS Significantly more people quit smoking in the experimental condition than in the control conditions, and the planning instructions changed intention to quit and perceived control over quitting, but not behavior. Stage of change moderated these effects such that implementation intentions worked best for individuals who were in the preparation stage at baseline. CONCLUSION Harnessing both motivational and volitional processes seems to enhance the effectiveness of smoking cessation programs, although further work is required to clarify inconsistencies in the literature using the stages of change.

A volitional help sheet to increase physical activity in people with low socioeconomic status: A randomised exploratory trial

Volitional help sheets use Gollwitzers (1993) concept of implementation intentions as a vehicle to change behaviour using Prochaska and DiClementes (1983) processes of change. The present study designed and tested a volitional help sheet to increase physical activity in a group with low socioeconomic status (low-SES). Sixty-eight people (33 women, 35 men; mean age 27) with low-SES were randomly allocated to either an experimental group or a control group. Both groups received a questionnaire and a volitional help sheet; the only difference between the experimental and control groups was that the former were given explicit instructions to link occasions on which they were tempted not to be physically active with appropriate behavioural responses (processes of change). Physical activity (Metabolic Equivalent minutes per week) was the main outcome measure; behavioural intention and self-efficacy were the secondary outcome measures. The findings revealed significant increase in physical activity in the experimental condition, relative to the control condition, F (1, 66) = 7.28, p < 0.01, = 0.10, but no differences for social cognitive variables. Furthermore, the participants who were most responsive to the intervention engaged in more than three times the physical activity at baseline than those who received the intervention but did not subsequently change. The findings provide further support for volitional help sheets to change health behaviour and extend them to a group with low-SES. Further work is required to refine this intervention tool.

Predicting and explaining transtheoretical model stage transitions in relation to condom-carrying behaviour

OBJECTIVES The stages of change component of the transtheoretical model have been applied to safe sex behaviours in cross-sectional analyses, but have not yet been subject to prospective analysis. It was predicted that: (a) cross-sectional analyses would demonstrate good discrimination between the stages of change; (b) prospective analyses would allow for the identification of predictors of stage transitions; and (c) implementation intentions would explain progression from the preparation stage. DESIGN This study employed an experimental longitudinal design. Participants were randomly assigned to the experimental (implementation intention) or control conditions and completed questionnaires at baseline and at 2-month follow-up. METHODS Five hundred and twenty-five adolescents who were broadly representative of the UK population completed questionnaires at baseline and follow-up (N=393) measuring: demographic variables; stage of change; theory of planned behaviour constructs; anticipated regret; and moral norm in relation to condom-carrying behaviour. The experimental condition completed a self-generated implementation intention to carry condoms at the end of the baseline questionnaire. RESULTS Discriminant function analyses indicated that the stages of change could be accurately discriminated from one another cross-sectionally and that, longitudinally, the measured variables were able to predict transitions between most stages. Implementation intentions caused people to progress from the preparation stage. CONCLUSIONS Transitions between most stages were reliably predicted, thereby providing potential targets for intervention. The brief implementation intention intervention was effective and could easily be utilized and expanded to encompass a broader range of sexual health behaviours.

Factors Associated With Breastfeeding Up To 6 Months Postpartum in Mothers With Diabetes

OBJECTIVES To identify breastfeeding behavior in a group of women with diabetes and to determine factors that may influence breastfeeding rates in this population. DESIGN A 2-year retrospective study. SETTING Derby City General Hospital, Derby, UK. PARTICIPANTS Ninety-four women with diabetes. METHODS Data were collected using questionnaire and maternal clinical records. RESULTS Women with gestational diabetes mellitus intended to and breastfed more than women with type 1 and type 2 diabetes at 2 weeks postpartum (p<.05). Logistic regression showed that the type of diabetes was the most significant predictor of breastfeeding at birth (p<.05). At 1, 2, and 6 weeks and 4 months postpartum, maternal body mass index was negatively associated with breastfeeding (p<.05). At 6 months, socioeconomic status predicted breastfeeding (p<.05). CONCLUSION Type of diabetes is a significant predictor of breastfeeding initiation. At later stages of postpartum, maternal body mass index and socioeconomic status were significant predictors of infant feeding method. Identification of these factors can help in developing appropriate and timely interventions to more effectively promote breastfeeding.

Felt and Potential Ambivalence across the Stages of Change

This study tested discontinuity patterns across the stages of change. Fat intake, theory of planned behaviour (TPB) variables, and felt and potential ambivalence were assessed in 16–17 year olds (N = 187). Across the stages of change there were: (a) linear increases in TPB variables, (b) linear decreases in fat intake, and (c) quadratic relationships with felt and potential ambivalence. Although felt and potential ambivalence were moderately correlated, the correlation between the two was significantly higher in the action and maintenance stages. The findings are consistent with the idea that successful actors/maintainers are vigilant with respect to lapses.

A volitional help sheet to reduce binge drinking in students: A randomized exploratory trial

AIMS This study tested the ability of a volitional help sheet (VHS) to decrease binge drinking in UK students. METHODS Fifty-six participants were randomly allocated to one of three conditions: control, active control or VHS as part of a questionnaire-based study. RESULTS There were significant decreases in units of alcohol consumed and self-reported binge drinking frequency in the VHS condition, but not in either of the control conditions. CONCLUSIONS The findings support use of the VHS to help people to reduce their alcohol consumption and binge drinking.

A Volitional Help Sheet to Reduce Alcohol Consumption in the General Population: A Field Experiment

Volitional help sheets (VHS) have been shown to be effective in changing health behavior, but not yet alcohol consumption in a general population. The aim of the present research was to test the ability of VHS to reduce alcohol consumption against an active control condition, a “standard” self-generated implementation intention condition, and forming a single implementation intention using the VHS. Sixty-nine participants were randomly allocated to one of four conditions: active control, VHS: single implementation intention, VHS: multiple implementation intentions and self-generated implementation intention. The main outcome measure was alcohol intake, assessed using a version of the timeline follow-back technique. Subsequent alcohol consumption decreased by more than 0.5 standard units (8 grams) per day in each of the experimental conditions (ps < 0.05), but increased marginally (0.05 units/day) in the active control condition. There were no significant differences in cognition or behavior between the three experimental conditions. The findings support the efficacy of a new VHS to reduce alcohol consumption. Further research is needed to identify alternative means by which people may form implementation intentions.

A brief psychological intervention that reduces adolescent alcohol consumption.

OBJECTIVE Alcohol consumption in adolescence is associated with problem drinking in later life, and there is a need to develop evidence-based interventions to reduce adolescent alcohol consumption. The aims of the present study were to test the ability of a very brief intervention based on self-affirmation theory to reduce alcohol consumption in a sample of adolescents and to examine potential mediators of the effects. METHOD 67 adolescents were randomly allocated either to form a self-affirming implementation intention or to complete a distractor task. All participants were exposed to a threatening message concerning the health risks of alcohol consumption. The main outcome measure was subsequent alcohol intake, but message processing (operationalized as perceived threat and message derogation), behavioral intention, and self-efficacy were also measured as potential mediators. RESULTS The intervention produced a significant decrease in alcohol consumption: Participants in the self-affirming implementation intention condition consumed 2.48 fewer grams of pure alcohol per day at the end of the study than adolescents who completed the distractor task. The effect was not mediated by perceived threat, message derogation, behavioral intention, or self-efficacy. CONCLUSIONS The findings provide support for the efficacy of the self-affirming implementation intention for promoting health behavior change and extend previous research by testing an adolescent sample and observing longer term effects. Further research is needed to find out what mediates the effects of self-affirming implementation intentions on health behavior change.