Revisiting the Transtheoretical Model for Physical Activity: A Large-Scale Cross-Sectional Study on Japanese-Speaking Adults.

BACKGROUND: The Transtheoretical Model (TTM) has been the basis of health promotion programs, which are, for example, used to tailor behavioral interventions according to the stages of change. Empirical studies have shown that the TTM effectively describes the processes of behavioral adaptation to acquire healthier lifestyles; however, it has been argued that TTM-based interventions are not superior to non-TTM-based interventions for promoting physical activity (PA). Evidence has also highlighted some inconsistencies with theoretical assumptions, especially regarding how each process-of-change strategy emerges across the stages. PURPOSE: Therefore, we investigated (a) how well the TTM describes the distributional characteristics of PA levels as well as other relevant variables (e.g., process of change, self-efficacy) across stages, and (b) how predictive the TTM variables are of PA levels within each stage. METHODS: We analyzed data from 20,573 Japanese-speaking adults who completed online questionnaires on PA and TTM variables. RESULTS: The results replicated previous findings that stage membership is associated with PA, the process of change, decisional balance, and self-efficacy, albeit with inconclusive evidence of temptations. Regression analyses revealed that some processes of change (self-reevaluation, reinforcement management, and self-liberation) were more predictive of PA in pre-active stages than in post-action stages; self-efficacy was predictive of PA only in the maintenance stage but not in the other stages. CONCLUSIONS: Overall, the data support the theoretical assumptions of the TTM, but the stage specificity of the active processes may not always be consistent with the theory.

The Transtheoretical Model has been the basis of many behavioral interventions for promoting physical activity. One of the key concepts of the model is the stage of change, which is a framework to help understand the readiness to begin physical activity and exercise. The model assumes five progressive stages of behavior change (e.g., the precontemplation stage, where people have no intention to change behavior; the maintenance stage, where people have continued physical activity for a long enough period), through which individuals acquire an active lifestyle. The model also assumes that different strategies for behavior change are appropriate at different stages and, confidence and attitudes toward physical activity vary dynamically across stages. The current study examined how valid these theoretical assumptions using data from 20,573 Japanese-speaking adults. The data overall supported the assumptions of the Transtheoretical Model, for example, highlighting the importance of enhancing awareness about the causes and (dis)advantages of being (in)active at earlier stages. Although some inconsistencies were identified (some strategies were not as useful as the model assumed), these findings may suggest that the Transtheoretical Model holds universal theoretical value as a descriptive model of behavioral change for active lifestyle across Western and East Asian populations.

Enhancing physical activity participation among female employees: evaluating the effectiveness of an educational intervention.

This paper evaluates the effectiveness of an educational intervention based on the transtheoretical model aimed at increasing physical activity (PA) participation among female employees in Bandar Abbas city (Iran) healthcare centers in December 2017 and August 2018. Using a semi-experimental interventional study design with a randomized and multi-stage method, 100 participants were included in both the intervention (n = 50) and control groups (n = 50). Data collection involved questionnaires assessing demographic information (age, gender, marital status and education), stages of change in PA behavior, Perceived Benefits, Barriers and Self-efficacy. The data were analyzed using SPSS-16, employing both descriptive (mean, SD, frequency, percentage) and inferential statistics (t-tests, chi-squared tests, etc.). Prior to the educational intervention, 19 participants (0.38%) in the intervention group engaged consistently in PA (stages 4-5). After 3 and 6 months of intervention, these numbers increased to 29 (0.58%) and 25 (0.50%), respectively. This improvement was statistically significant compared to the pre-intervention stage (P < 0.001). The findings highlight the importance of theory-based behavior change models and health education programs in promoting PA and combating sedentary lifestyles. Although focused on a specific population in Bandar Abbas, the intervention can serve as a model for similar programs targeting diverse social classes and populations.

Does a one-session sexual health education program improve sexual confidence in patients with cervical cancer? A transtheoretical model-based clinical study.

PURPOSE: This study aimed to evaluate the effects of a one-session sexual health education program using a transtheoretical model to enhance sexual self-efficacy in patients with cervical cancer. METHODS: This study recruited patients with cervical cancer from the gynecological wards of a medical center in northern Taiwan. A total of 63 participants were divided into 2 groups: the control group (n = 30) received traditional sexual health education. The intervention group (n = 33) participated in a transtheoretical model (TTM)-based sexual health education program. Scores from self-report questionnaires for variables of knowledge, attitudes, and self-efficacy regarding sexual health collected 1 and 6 weeks after the intervention were compared with baseline scores. RESULTS: Patients who received transtheoretical model (TTM)-based sexual health education had significantly greater sexual knowledge (ß = 3.794, p < 0.01), sexual attitudes (ß = 9.226, p < 0.01), and sexual self-efficacy (ß = 17.053, p < 0.01) than those who received traditional sexual health education at 1 and 6 weeks. CONCLUSION: Our findings suggest that a one-session sexual health education using a TTM-based model can enhance sexual knowledge, attitudes, and sexual self-efficacy among patients with cervical cancer. This educational program can be translated into routine clinical practice to help patients with cervical cancer enhance their sexual health and improve confidence in their sexual well-being.

Stages of Change toward Meat Reduction: Associations with Motives and Longitudinal Dietary Data on Animal-Based and Plant-Based Food Intakes in French Adults.

BACKGROUND: Reducing meat consumption is advocated for healthier and more sustainable diets. However, behavioral studies are needed to better understand the mechanisms underlying meat-reducing dietary changes. OBJECTIVES: The main aim of this study was to compare the motives associated with stages of change toward meat reduction in French adults, using the transtheoretical model (TTM). A second aim was to investigate the associations between stages of change and adherence to dietary patterns favoring a better balance of animal and plant food consumption over time. METHODS: This longitudinal study included 25,143 non-vegetarian participants of the web-based NutriNet-Santé cohort with a mean follow-up of 6.2 (SD = 2.6) y. Dietary data were obtained from 24-h dietary records over the period 2009-2019. The contribution of meat to total energy intake and scores measuring the contribution of healthy and unhealthy plant-based foods to the diet were computed. A questionnaire completed in 2018 allowed us to identify the TTM stages of change related to meat reduction (precontemplation, contemplation, preparation, action, and maintenance), and recorded motives related to meat consumption. We used multivariate linear mixed models for repeated data to assess associations between food intake changes and stages, and logistic regression for motives, presented as adjusted frequencies. RESULTS: Participants in later stages were characterized by a significantly higher decrease in meat intake over time, compared with the earliest stage (for example, ßmaintenance ∗ time = -0.08, P < 0.0001), and a higher increase in the healthy plant-based food consumption score over time (for example, ßmaintenance∗time = 0.11, P < 0.0001). Concerns about health, nutrition, and the environment were the most frequently cited motives for reducing meat consumption at all stages. CONCLUSIONS: Individuals who had already initiated meat reduction adhered to healthier and more sustainable diets than meat continuers. Characterizing motives according to readiness to reduce meat consumption could support tailored public health campaigns. TRIAL REGISTRATION NUMBER: The study protocol is registered at clinicaltrials.gov with Clinical Trial Registry number NCT03335644 available at https://clinicaltrials.gov/ct2/show/NCT03335644.

Enduring Relevance of the Stages of Change Model for Transforming Lifestyle Behaviors.

BACKGROUND: The applicability of the Stages of Change model for cardiovascular disease-related behaviors, such as smoking, exercise, diet, and sleep quality, is unclear.Methods and Results: Using a large-scale epidemiological dataset, we found that baseline behavior change intention, as per the transtheoretical model, was associated with modifications of unhealthy lifestyles including cigarette smoking, physical inactivity, skipping breakfast, and poor sleep quality. CONCLUSIONS: Our results suggest that an individual's motivation to change assessed by a general questionnaire may contribute to lifestyle modification and potentially prevent subsequent cardiovascular disease.

Gradual behaviour change towards meat reduction: Development and validation of a novel decisional balance scale.

Meat reduction is gaining attention among consumers, marketers, policymakers and scientists. Yet little is known about decision-making processes and behaviour change towards meat reduction. This paper explores the applicability of the decisional balance (DB) framework to the field of meat reduction. A novel DB scale to measure the perceived importance of beliefs about meat reduction at different stages of behaviour change was developed and validated in two studies with German meat eaters. In Study 1 (N = 309), the item inventory was tested using an exploratory factor analysis and then validated in Study 2 (N = 809). The results yielded two higher-order DB factors (pros and cons), which were subdivided into five lower-order factors (perceived benefits of a plant-based diet, downsides of factory farming, health barriers, legitimation barriers and feasibility barriers). The pros and cons were summarised in a DB index. All DB factors and the DB index were tested for internal consistency (Cronbach's alpha ≥.70) and aspects of validity. The typical DB pattern of the pros and cons of behaviour change was confirmed: the cons outweighed the pros for consumers who did not intend to reduce meat consumption, while the pros outweighed the cons for consumers who intended to reduce meat consumption. The new DB scale for meat reduction has proven to be a suitable measure to gain insights into consumers' decision making and could be used to develop targeted meat reduction interventions.

Applying Stages of Change Model to Examine Online Peer Communication on Binge Eating.

Despite the distress and disruption associated with eating disorder (ED), people struggling with EDs are often ambivalent about their eating issues and unmotivated for recovery. Rather than seek professional help, these people tend to turn to online ED groups for information and support. Using the stages of change model, this study investigates the characteristics of online peer communication around binging vis-à-vis participants' motivation and readiness for behavioral change. Our results illustrate how individuals with binging issues in different motivational stages discuss their problematic eating online and provides insights into their ambivalence toward treatment and relapses into binging. This study further clarifies how people with binging issues feel trapped in a cycle of dieting-binging, which is observed to be undergirded by unresolved weight-related issues, and how they cope with the stressful relationship between eating and body weight through their postings on social media. These findings suggest that healthcare providers should promote healthier methods of addressing the weight gain from binge eating and provide support tailored to individuals' motivational stage in breaking the dieting-binging cycle.

Motivational Interviewing and Chronic Care Management Using the Transtheoretical Model of Change.

The number of Americans living with chronic health conditions has steadily increased. Chronic diseases are the leading causes of death and disability in the United States and cost the healthcare system an estimated $4.1 trillion dollars a year. The role of social workers in assisting patients in the management of their chronic diseases is vital. The behavioral health changes often required of chronic care management (CCM) patients require support and intervention by professionals to help the patient improve self-management of their chronic health conditions. Motivational interviewing (MI) is an evidence-based practice that helps people change by paying attention to the language patients use as they discuss their change goals and behaviors. Applying the principles and strategies of MI within the stages of change model (transtheoretical model of change) can help social workers better understand and assist patients receiving CCM. This article outlines specific strategies the social worker can use to address motivation at different stages of change.

Change lifestyle modification plan/transtheoretical model in non-alcoholic simple fatty liver disease: a pilot randomized study.

BACKGROUND: Non-alcoholic simple fatty liver disease patients have very low compliance with almost all types of physical activities. A transtheoretical model-oriented lifestyle modification plan awakens the patient's consciousness in the pre-intention stage. Aim to evaluate whether a management by stages of change plan based on the Transtheoretical Model and Stages of Change promoted behavior change for patients with non-alcoholic simple fatty liver disease. METHODS: Patients with simple fatty liver diagnosed from July to December 2019 were randomly divided into the transtheoretical model and non-transtheoretical model groups. Primary outcome was change in health belief and health behavior based on questionnaires. Secondary outcomes included changes in blood lipids, body mass indexes, and waist circumference 12-months after intervention. RESULTS: Of 200 enrolled patients 194 were analyzed (non-transtheoretical model group n = 98, transtheoretical model group n = 96). After intervention, total health belief scores (120.91 ± 4.94 vs. 118.82 ± 5.48) and total health behavior scores (131.71 ± 5.87 vs. 119.96 ± 7.12) were higher in the transtheoretical model group (all P < 0.05). Blood lipids, body mass index, and waist circumference more obviously improved in the transtheoretical model group (all P < 0.05). CONCLUSION: A transtheoretical model-based lifestyle modification intervention can be effectively applied to patients with non-alcoholic simple fatty liver. CLINICAL RESEARCH REGISTRATION NUMBER: ChiCTR2100049354. The registration date is August 1, 2021.

Stages of a Transtheoretical Model as Predictors of the Decline in Estimated Glomerular Filtration Rate: A Retrospective Cohort Study.

BACKGROUND: The transtheoretical model (TTM) is composed of the multiple stages according to patient's consciousness and is believed to lead people to realize the importance of healthier behaviors. We examined the association of TTM stages with the decline of estimated glomerular filtration rate (eGFR). METHODS: We used the annual health checkup data and health insurance claims data of the Japan Health Insurance Association in Kyoto Prefecture between April 2012 and March 2016. TTM stages of change obtained from questionnaires at the first health checkup and categorized into six groups. The primary outcome was defined as a more than 30% decline in eGFR from the first health checkup. We fitted multivariable Cox proportional-hazards model for time-to-event analyses adjusting for age, sex, eGFR, body mass index, blood pressure, blood sugar, dyslipidemia, uric acid, urinary protein, and existence of kidney diseases at first health checkup. RESULTS: We analyzed 239,755 employees and the mean follow-up was 2.9 (standard deviation, 1.2) years. As compared with the stage 1 group, the risk of eGFR decline was significantly low in the stage 3 group (hazard ratio [HR] 0.77; 95% confidence interval [CI], 0.65-0.91); stage 4 group (HR 0.80; 95% CI, 0.65-0.98); and stage 5 group (HR 0.79; 95% CI, 0.66-0.95). CONCLUSION: Compared with the precontemplation stage (stage 1), the preparation, action and maintenance stages (stages 3, 4, and 5), were associated with a lower risk of eGFR decline.

Transtheoretical model-based mobile health application for PCOS.

BACKGROUND: Lifestyle modification (diet, exercise, and behavioral interventions) is the first-line treatment for polycystic ovary syndrome (PCOS). The benefits of face-to-face lifestyle modification intervention in a short time have been demonstrated. However, few studies have investigated the mobile technology effects on lifestyle modification in PCOS. Therefore, we examined the effect of transtheoretical model-based mobile health application intervention program for PCOS. METHODS: A randomised controlled, single-blind trial, was carried out from October 2018 to March 2019, which included 122 participants recruited from gynecology outpatient clinics of affiliated Hospital of Zunyi Medical University in Guizhou. The study participants were randomised into intervention (n = 61) and control groups (n = 61). Participants in the intervention group undertook a TTM-based mobile health application program in addition to routine care, and participants in the control group received only routine care. RESULTS: Fifty-one participants in the intervention group and 49 in the control group completed the study. Compared to the control group, participants in the intervention group showed statistically significant decrease for BMI (P < 0.05), WC (P < 0.05), SAS (P < 0.05), and SDS (P < 0.05) scores at 6-month and 12-month, respectively. Behavior stage change of exercise and diet among paticipants with PCOS was significant at 6 months (c2 = 43.032, P < 0.05) and 12th months (c2 = 49.574, P < 0.05) between the intervention and control groups. CONCLUSIONS: This study showed that the TTM-based mobile health application program can decrease BMI, WC, anxiety, and depression, and improve exercise and diet adherence in patients with PCOS in the long term. The TTM-based mobile health application program can be applied for lifestyle modification in women with PCOS. Trial registration This study was approved by the ethics committee NO.[2019]1-028 in March 2018 and was registered at the Chinese Clinical Trial Registry (website: www.chictr.org.cn , registry number: ChiCTR2000034572).

Poor adherence of life management in patients with PCOS and many then go on to adherence poor health outcomes as a result. There is an urgent need for new approach to enhance to life management compliance for patients with PCOS. TTM is a common behavior change model, which can effectively promote the behavior change of patients, but it has not been used in the life management of PCOS patients. Meanwhile, the traditional life management of PCOS is mainly face-to-face intervention, few studies have investigated the mobile technology effects on lifestyle modification in PCOS. This study aimed to evaluate the long-term effects of TTM-based mobile technology (for lifestyle modification) on the maintenance of health-related behavior changes among women with PCOS. This study confirmed that the TTM-based mobile health application program can decrease BMI, WC, anxiety, and depression, and improve exercise and diet adherence in patients with PCOS in the long term. Our study conducted TTM-based mobile health application program can provide a reference for other researchers or research organizations.

Implementation of the Enhanced Transtheoretical Model Intervention (ETMI) for Low Back Pain Patients in Primary Care: Study Protocol.

BACKGROUND: Self-management, an active life routine, and adherence to physical activity are effective in the management of low back pain (LBP). However, delivering effective education and reassurance to patients can be a difficult for practitioners. The enhanced transtheoretical model intervention (ETMI) has shown to be successful and cost effective. The intervention focuses on educating practitioners to reassure patients, empower them to increase physical activity, and improve their self-efficacy. OBJECTIVES: To assess whether ETMI can be implemented among primary care practitioners and to examine whether it reduces pain, disability, and fear avoidance as well as decreasing healthcare utilization. This protocol outlines the methodology for the implementation of ETMI through a hybrid implementation-effectiveness design. METHODS: Two qualitative and mixed-method studies provided a basis for an implementation prospective cohort study. Discussions are followed by a prospective cohort study with pre-and post-intervention measures as well as descriptions retrieving economic and therapeutic outcome data from the Maccabi Healthcare Services (MHS) databases. In addition, a fourth qualitative study was conducted at the midpoint of the implementation to evaluate the process by measuring the perceptions and practice of practitioners. The intervention group was 220 primary care practitioners and their patients (~n=10,000) from the central district of MHS. The control data was provided by other care districts with similar socioeconomic makeup (~n=40,000). CONCLUSIONS: We evaluated the process and outcomes of the implementation of ETMI. We investigated the relationship between the care received (ETMI against treatment as usual) and healthcare utilization, costs, and patient-clinical outcomes.

Can the Enhanced Transtheoretical Model Intervention (ETMI) Impact the Attitudes and Beliefs Regarding Low Back Pain of Family Medicine Residents.

BACKGROUND: Low back pain has been the leading cause for disability worldwide for several decades, and clinical guidelines for its management clearly emphasize a multifactorial approach. Yet, current guidelines are still not well implemented by clinicians. OBJECTIVES: To explore the attitudes of family medicine residents regarding low back pain and to determine whether they positively correlate with their treatment approaches. To test if these attitudes can be affected by the Enhanced Transtheoretical Model Intervention (ETMI), a guideline-based workshop. METHODS: Participants completed an online questionnaire regarding their attitudes toward low back pain and clinical habits, after which they attended an online ETMI educational workshop. One month later all participants were asked to complete the questionnaire a second time. Statistical analysis was conducted to explore the attitudes of the residents and clinical approaches, as well as any associations between them, as well as possible differences pre- and post-intervention. RESULTS: The participants exhibited highly psychologically oriented attitudes. Correlations between the attitudes and treatment did not show consistent coherency. Results regarding the participants clinical approaches were revealed to have two distinct and opposed inclinations: biomedically and biopsychosocially. Last, results for the re-activation subscale were significantly higher post-intervention. CONCLUSIONS: Family medicine residents seem to be highly psychologically oriented regarding low back pain; however, they do not necessarily treat their patients accordingly. Their clinical choices seem to follow two different approaches: guideline-consistent and non-guideline-consistent. An ETMI guideline-based workshop may sway their attitudes toward re-activation of patients. Further research is needed to determine whether similar results would arise in larger physician populations.

Understanding farmers' conservation behavior over time: A longitudinal application of the transtheoretical model of behavior change.

Global waterbodies are experiencing increased risk of eutrophication and harmful algal blooms due to excess nutrients including phosphorus and nitrogen discharged from human activity on the landscape and as a result of climate change. Despite modeling that suggests the efficacy of best management practices in agricultural systems to be sufficient to address the problem, adoption by farmers remains far below the levels needed to achieve significant water quality improvements and new approaches to encourage and sustain adoption are urgently needed. In this work, we apply a modified transtheoretical model (TTM) of behavior change to a longitudinal dataset (N = 584) of farmers' adoption decisions and stated intentions to use cover crops, collected in the Maumee Basin of Lake Erie, USA in 2016 and 2018. The TTM posits that behavior changes over time and is influenced by different social-psychological processes at each stage of change. Our findings confirm past research into the importance of many of the factors investigated, while providing new insight into their role in specific stages of the change process with potential implications for the design of interventions for farmers in different stages. Several factors investigated (mean environmental concern, education, information from conservation groups and off-farm income) were uniquely important to a particular stage. Other factors (response efficacy at the field level, total farm size and risks of spring planting interference) were important at both an earlier and later stage, but less important in predicting middle stages of change. A third set of factors (self-efficacy, proportion rented, no-till adoption and uncertain long-term paybacks) were statistically important across each stage of the TTM model. In applying the TTM longitudinally, we found evidence that farmers in a more advanced stage of cover crop adoption, in the first wave of data collection (2016) were more likely to have adopted cover crops in the second wave (2018), a result not predicted by individual factors alone. We report findings for cover crops but see the potential for the transtheoretical model of behavior change to be applied to other best management practice adoption decisions and to diverse populations of farmers to generate similarly novel insight and utility for intervention design and targeting.

Surface Chemistry Study of the Interactions of Sesame Oil with Meibomian Films.

A possible approach for the treatment of meibomian gland disease (MGD) can be the supplementation of meibomian gland secretion (MGS) with nonpolar lipids (NPL) rich plant oils. Sesame oil (SO), approximately equal in monounsaturated fat (oleic acid, 40% of total) and polyunsaturated fat (linoleic acid, 42% of total), has shown multiple health benefits due to its anti-inflammatory and antioxidant effects. Thus, the interactions between SO and MGS in surface layers deserve further study. Therefore, pseudobinary films were formed with controlled MGS/SO molar ratios (0%, 10%, 30%, 50%, and 100% SO) at the air/water surface of the Langmuir trough over phosphate buffered saline (pH 7.4) subphase. Surface pressure (π)-area (A) isotherms and Brewster angle microscopy observations showed nonideal interactions where SO aggregates with MGS and complements the NPL stratum of the meibomian layers. The analysis of stress relaxation transients with Kohlrausch-Williams-Watts equation revealed that the supplementation of fixed amount of MGS with excess lipids via SO altered the dilatational elasticity of the films as reflected by the increase of the exponent ß. Thus, SO with its unique combination of high oxidative stability and abundance of long polyunsaturated acyl chains might be a useful supplement to MGS layers.

The Transtheoretical Model based psychoeducation's effect on healthy lifestyle behaviours in schizophrenia: A randomized controlled trial.

OBJECTIVE: The study was conducted with the pretest-posttest randomized controlled trial design to detect the psychoeducation's effect, based on the Transtheoretical Model, on the healthy lifestyle behaviours of individuals with schizophrenia. METHODS: The data were collected from 82 participants, as 41 intervention and 41 control. The data were collected via personal information form, behavioural change stage diagnosis form and healthy lifestyle scale II. 6-week psychoeducation, consisting of 6 modules, based on the Transtheoretical Model, was applied to the intervention group. No interventions were applied to the control group. Pretests and posttests were applied to both groups. RESULTS: When the healthy lifestyle scale II of intervention and control groups and final test results arranged according to ANCOVA analysis are compared, average final test results were meaningfully positive for the intervention group with taking control of the pretest and other covariants. When the pretest-posttest results in terms of behavioural change of the intervention group are evaluated; a meaningful difference among nutrition, physical exercises, spiritual self-improvement and stress management, which all are the stages of behavioural change, was detected. CONCLUSION: It was determined that psychoeducation on a healthy lifestyle, based on the Transtheoretical Model in an individual with schizophrenia affected physical exercises, spiritual self-improvement and interpersonal relationships sub-dimension in medium level, and had a drastic influence on health responsibility, nutrition, stress management sub-dimensions and all healthy lifestyle behaviours. Progress in behavioural change stages was detected. CLINICAL TRIALS ID: NCT05259748.

Facilitating behavior change: Introducing the Transtheoretical Model of Behavior Change as a conservation psychology framework and tool for practitioners.

The primary opportunities for improved conservation and sustainability outcomes are through changing human behavior. Zoos, aquariums, and other public-facing biodiversity conservation institutions offer an important space for environmental learning and facilitating proenvironmental behavior change. We have focused, in this review, on examining common behavior change models as well as the Transtheoretical Model (TTM) of Behavior Change​​​​​, a widely regarded model within the health fields and, recently, in the fields of environmental and leadership studies, with new research applying the TTM specifically in a zoo setting. We have discussed critiques of the TTM and rebuttals to those critiques. We have presented examples of TTM applications in a zoo setting. Our objective has been to explore the TTM as a possible "best fit" framework and tool for zoo and aquarium practitioners in facilitating proenvironmental behavior. Key findings include that (a) the TTM differs significantly from other proenvironmental behavior theoretical models, including those that are prevalent in the conservation psychology literature and applied by zoos and aquariums, in terms of the TTM stages of change and processes of change constructs; (b) the TTM appears to overlap significantly with the 10 interventions or treatments identified by researchers as the most effective approaches to facilitating proenvironmental behavior; and (c) there is nascent and promising application of TTM constructs in zoo and aquarium programming. We remain impressed by the potential of the TTM to address a critical question within the conservation psychology research field concerning proenvironmental behavior: what specific tools to employ and when.

Effect of a Transtheoretical Model-based intervention on fruit and vegetable intake according to perception of intake adequacy: A randomized controlled community trial.

Interventions based on the Transtheoretical Model (TTM) are usually effective at increasing fruit and vegetable (FV) intake, but it is not known whether individuals with misperceived intake [e.g., in pseudomaintenance (PM)] for FV intake also benefit from these interventions. This study aims to describe the effectiveness of a TTM-based intervention for FV intake according to baseline perception of intake adequacy. A randomized controlled community trial was carried out with 3414 users of a health promotion service in Belo Horizonte, Brazil, aged 20 years or over, in 2013-2014. FV intake was estimated using a validated instrument. PM was identified when participants had insufficient FV intake and thought their intake was adequate. The intervention group (IG) received a TTM-based intervention, and the control group (CG) received usual care. Baseline FV intakes were lower among individuals in PM compared to those with a concordant perception (CP). In both the IG and CG, FV intake increased among those in PM. Fruit intake remained stable, and vegetable intake decreased among those with CP. Generalized estimating equations revealed a significant effect of the intervention on fruit intake at follow-up, which was slightly higher among those in PM. We conclude that participants in PM were partially sensitive to the intervention and improved fruit intake at follow-up. We suggest that future studies emphasize vegetable intake and elucidate how TTM pillars (self-efficacy, decisional balance, processes of change) can be best used to increase FV intake.

Explaining intention to reduce red and processed meat in the UK and Italy using the theory of planned behaviour, meat-eater identity, and the Transtheoretical model.

This study aimed to contribute to the growing literature investigating the psychosocial factors associated with intentions to reduce red and processed meat consumption, given the significant negative impact of meat on public health and in contributing to climate change. A framework combining the Theory of Planned Behaviour with meat-eater identity and the Transtheoretical Model was used to explain intention to reduce red and processed meat consumption across participant samples in the UK and Italy, to identify the factors involved in encouraging behaviour change whilst also considering differences in culinary practices. University students in the UK (n = 320) and Italy (n = 304) completed an online survey including measures from the Theory of Planned Behaviour and the Transtheoretical Model, as well as a measure of meat-eater identity. The results showed differences in the relative impact of subjective norm, perceived behavioural control, and meat-eater identity, on behavioural intention across the different stages of change and across the two countries. On the other hand, attitude remained a stable predictor across the different stages of change and in both countries. The results are discussed in relation to existing literature, with the goal of increasing understanding of how reduced meat consumption might be encouraged across different populations.

Integration of the Theory of Planned Behavior and Transtheoretical Model of Change for Prediction of Intentions to Reduce or Stop Alcohol Use among Thai Adolescents.

BACKGROUND: Alcohol use among Thai adolescents has been increasing over the past few decades, and efforts to control consumption by underaged youth have proven largely ineffective. Objectives: This study tested components of the Theory of Planned Behavior (TPB) and Readiness to Change, based on the Transtheoretical Model (TTM), to identify useful constructs for developing alcohol use interventions for youth. Methods: A sample of 825 Thai student drinkers (65% female), between the ages of 14 and 19, were recruited in Bangkok, Thailand. Hierarchical regression analyses were used to test components of the TPB and Readiness to Change as predictors of intention to reduce/stop alcohol use while controlling for age, gender and alcohol use. Results: The model accounted for 58% of the variance of intentions. The TPB components accounted for a significant increase in variance beyond that explained by age, gender and alcohol use, ΔR2 = .23, p < .001; Perceived Behavioral Control (PBC) was the strongest predictor (ß =.41, p < .001), followed by Attitudes (ß=.13, p < .001), and Subjective Norms (ß =.09, p = .002). Readiness to Change composite scores (ß=.54, p < .001) were added last and accounted for a further significant increase, ΔR2 = .24, p < .001. Conclusions: The findings suggest that interventions should assess Readiness to Change and utilize effective processes in facilitating change at each stage. Other suggestions are to improve participants' PBC and to further examine the role of specific social norms and attitudes regarding perceived benefits and disadvantages of alcohol use.