Validating Stages of Change for Obesogenic Behaviors Across Filipino and Other Asian-American and Pacific Islander Adolescents.

Filipino adolescents are underrepresented in obesity research, although Filipinos are the second largest Asian-American and Pacific Islander (AAPI) subpopulation in the USA. An understanding of how well the theories of behavior change apply to Filipino and other AAPI adolescents is critical to addressing obesogenic behaviors in these groups. This study aimed to validate the transtheoretical model of behavior change (TTM) for physical activity (PA) and fruit and vegetable intake (FV) among a majority Filipino adolescent population. Adolescents in grades 9-11 (N = 159, 82.4% female) completed measures of PA and FV behaviors and PA and FV stages of change. One-way ANOVAs and Tukey's HSD post hoc tests were computed to assess the validity of the PA and FV stages of change with the respective behaviors. There was a significant effect for fruit (action > contemplation, preparation) and vegetable (maintenance, action > contemplation) intakes across the FV stages of change. There was a significant effect of strenuous PA (precontemplation/contemplation, preparation < action < maintenance) and moderate PA (precontemplation/contemplation < action, maintenance) across the PA stages of change. Some variability in associations emerged when the sample was stratified by gender. This study provides validity evidence for the TTM stages of change for FV and PA among Filipino and other AAPI adolescents. This validation, in turn, extends the generalizability of the stages of change construct to include this ethnic group and replicates other adolescent studies.

Evaluation of an Emerging Research Center: Lessons Learned.

PROBLEM STATEMENT: Rigorous evaluation assures that research endeavors meet their purpose and achieve stated goals. This is especially true for federally funded exploratory research centers, which tend to be more complex due to the involvement of multiple, interdisciplinary investigators. This study provides an overview of the approach used to develop an evaluation strategy and reports the lessons learned during the initial development of the Center for Ohana Self-Management of Chronic Illness (COSMCI) at the University of Hawai'i at Manoa School of Nursing and Dental Hygiene. The COSMCI is composed of an interdisciplinary team of researchers and practitioners and aims to advance knowledge in the field of self management of chronic disease in the community setting. APPROACH: A systematic approach was utilized that included formative and summative strategies for ongoing evaluation. The problem was solved by addressing five key concerns: (1) development of research structure, (2) observing the process of the research pilot projects, (3) scholarly activity of COSMCI faculty, (4) dissemination and translation and (5) sustainability prospects. The method of research included formulating process strategies and determine if the plans for developing the Center were followed and whether these plans were effective. Interviews were also conducted at year one and at mid-point though the project. RESULTS: Themes that emerged from our evaluation included inclusion, timelines, realistic expectations, ongoing evaluation and preparing for changes in the team. This provided timely recognition of successes and challenges and facilitated a rapid response for interventions especially during the early development stage of the center. CONCLUSION/RECOMMENDATIONS: Effective development of a successful Center is highly dependent upon having a strong evaluation process in place that can inform ongoing development. An exploratory research center requires ongoing evaluation that allows for celebration of successes, as well as early identification of problems and rapid response.

Systematic counselling by general practitioners for promoting physical activity in elderly patients: a feasibility study.

RESEARCH QUESTIONS: To investigate how the daily physical activities of elderly patients can be enhanced by systematic counselling conducted by general practitioners (GPs). METHODS: In this feasibility study with pre-post design, 29 people (14 females, mean age 72.2 years, SD = 6.1) were enrolled during routine visits by two general practitioners. A baseline assessment of current physical activity based on the stages according to the Transtheoretical Model was followed by a counselling session. The target behaviour was defined by performance of 30 minutes of daily moderate-intensity activities that increase the breathing rate, on five days per week. At the 2-month follow-up, subjects were assessed for improvement in stage of physical activity since baseline. After the end of the intervention, participating GPs and patients were asked questions focusing on the feasibility, acceptance and usefulness of counselling. RESULTS: Interview results showed that the two GPs considered the counselling protocol easy to handle and useful for promoting physical activity. Counselling sessions were especially encouraging for the not sufficiently active people. Most of them would like to have additional counselling session. At baseline, 9 of 29 people were sufficiently active. After 2 months, this proportion was 21 of 29. The mean of the number of minutes of physical activity during the previous 4 weeks increased from 247 to 436 minutes (weekly). CONCLUSIONS: The programme was judged positively by the general practitioners and the participating elderly patients. Systematic counselling by general practitioners led to an increase in the physical activity behaviour. Therefore, a more rigorous randomised controlled trial with adequate followup is recommended.

Validation of the stages of change with mild, moderate, and strenuous physical activity behavior, intentions, and self-efficacy.

The stages of change construct of the Transtheoretical Model (TTM) has been proposed for examining exercise adoption. Studies investigating the construct validity of the stages of change for exercise have used physical activity of moderate or higher intensity as operationalization criterion. Since it has been shown that physical activity of lower intensity also provides health benefits, we investigated whether the stages of change appropriately address lower intensity physical activity. Data with respect to the stages of change as well as behavior, intention and self-efficacy associated with mild, moderate, and strenuous exercise were collected in a sample of 467 males and females aged 20 - 85. Results show that the stages of change can be distinguished by moderate and strenuous but are not consistent with mild exercise. Implications for future research utilizing the stage of change conceptualization are discussed and development of new stage assessment instruments for mild exercise is recommended.

Explaining adolescent exercise behavior change: a longitudinal application of the transtheoretical model.

The developmental decline and benefits of exercise are documented, however, relatively little is known about the mechanisms and motivations underlying adolescent exercise behavior This project investigates which variables drive exercise or are a consequence thereof, within the Transtheoretical Model (TTM). Baseline questionnaires (N = 819) were collected through 5 Canadian high schools. For this longitudinal investigation, all baseline participants were approached for a 3-year follow up. Follow-up questionnaire completers (n = 400: mean baseline age = 14.89, SD = 1.15, mean follow-up age = 17.62 years, SD = 1.18) were not different from noncompleters (n = 419) on all baseline variables, except for sex (54. 75% and 43. 68% females, respectively; p <. 003). Stages, processes, self-efficacy, pros and cons of exercise from the TTM, and self-reported exercise were assessed. Panel analyses revealed that although the directions of the relations were as hypothesized, the processes did not significantly lead to exercise or vice versa. As hypothesized, exercise leads to self-efficacy and pros and cons, showing that the TTM can serve as a framework to understand adolescent exercise behavior Future research needs to incorporate shorter assessment intervals and use larger samples to be able to look at adjacent stage transitions.

Validating motivational readiness for exercise behavior with adolescents.

The stages of motivational readiness as conceptualized by the Transtheoretical Model have been widely used among adult samples to assess readiness for adopting exercise behavior. To date, little research has been conducted using a staging framework with adolescent samples. There is a need for validation of the staging framework prior to a substantial amount of research with this age group. The current article presents two studies assessing stage and reported exercise behavior (Study 1: n = 819; M age = 15.0 years, SD = 1.2; 51% men; Study 2: n = 184; M age = 18.6 years, SD = .5; 45% men). As hypothesized in both studies, reported exercise consistently varied as a function of stage classification; those in earlier stages of readiness reported less exercise than those in later stages. Staging algorithms showed good sensitivity to detect reported exercise; however, specificity was distinctly better with the algorithm that used a specific activity criterion and immediate intention, as opposed to irregular behavior, in defining the preparation stage. Results support the validity of the staging framework for measuring motivational readiness for exercise behavior among North American adolescents.

Changing health behaviors of older adults.

1. Changing lifelong unhealthy habits can have a positive effect on health for older adults. 2. The Transtheoretical Model of behavior change proposes people move through a series of five stages and use a variety of processes as they attempt to change a behavior. 3. Research has shown that tailoring interventions to a individual's stage of change is most effective in promoting behavior change. 4. Specific stage-based strategies are recommended for nurses to use with both individuals and groups of older adults.

Interactive communication strategies: implications for population-based physical-activity promotion.

Physical inactivity is a recognized independent risk factor for the development of cardiovascular disease. However, a large proportion of the U.S. population does not participate in regular physical activity, and research has shown that without intervention, most people remain sedentary. Thus, an urgent need exists for developing effective interventions to promote physical-activity adoption and maintenance. Additionally, it is important that these interventions can be disseminated to the large population of sedentary individuals. To be disseminable, physical-activity interventions must move beyond reliance on strictly face-to-face modes and begin to more fully use newer technologies, such as the Internet. This article summarizes the progress made in promoting physical activity with interactive communications. We also delineate areas for future research.

Stages of change across ten health risk behaviors for older adults.

Owing to the recent success of the Transtheoretical Model of behavior change and the possible relationships between health behaviors, this study investigated the stage distribution of 10 healthy behaviors (seatbelt use, avoidance of high fat food, eating a high-fiber diet, attempting to lose weight, exercising regularly, avoiding sun exposure, sunscreen use, attempting to reduce stress, stopping smoking, and conducting cancer self-exams) and their interrelationships in a representative sample of health maintenance organization (HMO) members. The majority of older adults were found to be in either precontemplation or maintenance, illustrating the need to target interventions to precontemplation. Most older individuals were in precontemplation for losing weight and/ or sunscreen use and exercise, making these behaviors a priority for intervention research. Possible gateway behaviors to general health could be identified; however, these results are preliminary and require longitudinal follow-up.

Transtheoretical Model: examining adolescent exercise behavior.

PURPOSE: The entire Transtheoretical Model, consisting of stages of change, processes of change, self-efficacy, and decisional balance, was tested for its applicability to understanding exercise behavior in an adolescent population. METHODS: Students (n = 819) from five community high schools (Grades 9-12) completed self-administered questionnaires, all of which were adapted from previous literature. Stage of exercise behavior change served as the dependent variable. RESULTS: Distribution of the sample across the stages was: precontemplation, n = 17 (2.1%); contemplation, n = 34 (4.2%); preparation, n = 235 (28.7%); action, n = 129 (15.7%); and maintenance, n = 404 (49.3%). Univariate analyses of variance (p < 0.0038) followed up with Tukey's post-hoc analyses revealed that all of the constructs differed significantly across stages. Profile analysis indicated that pros and cons intersected in the action stage using t scores; however, when analyzing raw scores, this intersection was found to be in the precontemplation stage. DISCUSSION: Preliminary evidence was found for the applicability of the Transtheoretical Model to adolescents. The low rate of adolescents in the precontemplation and contemplation stages was not deemed a major limitation, owing to the purpose of the investigation.

A simple reinforcement strategy for increasing attendance at a fitness facility.

The purpose of the present study was to examine the effect of a previously untested reinforcement strategy (i.e., 1 month's free membership) on attendance at a fitness facility. Participants were paying members of a fitness facility randomly assigned to control (n = 100), placebo (n = 100), and reinforcement (n = 100) conditions. The control condition received no intervention; the placebo condition received a letter by mail; and the reinforcement condition received the same letter by mail, except that it included an additional paragraph instructing them that they could earn 1 month's free membership if they attended the fitness facility at least 12 times in the next month. Attendance was monitored for 1 month baseline and postintervention by using the facility's computer system. Analysis of variance, t tests, and chi-square analysis all revealed that the reinforcement condition had the best attendance record during the intervention period. These preliminary results shed some light on increasing attendance at a fitness facility. Discussion highlighted the practical implications of the findings and offered directions for future research.

Maintaining attendance at a fitness center: an application of the decision balance sheet.

The effect of a decision balance sheet intervention on attendance at a university fitness facility was examined. Facility members were randomly assigned to control, placebo, and experimental conditions. The control condition received no intervention, whereas the placebo and experimental conditions were called by telephone and asked to complete either an irrelevant (smoking) or relevant (exercising at the fitness facility) decision balance sheet. Attendance was monitored surreptitiously for 4 weeks baseline and 8 weeks post intervention. Statistical analyses indicated that the control and placebo conditions showed a significant decrease in attendance from baseline to intervention, whereas those in the experimental condition maintained attendance levels. Discussion focused on broadening the application of the decision balance sheet, determining its theoretical boundaries, and the necessity and appropriateness of decision alternatives for the decision balance sheet in the exercise domain.

Effect of a stimulus control intervention on attendance at a university fitness center.

The purpose of the present study was to determine the isolated effects of stimulus control on attendance at a fitness facility. Participants were members of a university fitness club randomly assigned to control (n = 50), placebo (n = 50), and stimulus control (n = 100) conditions. The control condition received no intervention, the placebo condition received a letter by mail, and the stimulus control condition received the same letter by mail plus a complimentary "EXERCISE" key chain, which was to act as the stimulus control. Attendance was monitored surreptitiously for 5 weeks baseline and 8 weeks postintervention by using the facility's computer system. A manipulation check found that 48 of the 100 participants used the key chain. Therefore, analyses were conducted separately for "intention to treat" and "actual treatment" conditions. Repeated measures multivariate analyses of variance revealed no main or interaction effects involving experimental condition in either the "intention to treat" or "actual treatment" analyses. Discussion focused on explanations for why the stimulus control intervention was not successful, and directions for future research were provided.

Reliability and validity of active, passive and dynamic range of motion tests.

The purposes of this project were to determine (a) the reliability of ROM and POM assessment methods for tests where an ankle joint brace was used and (b) the relationship between active and passive ROM and POM inversion measurements. The range of motion of the ankle joint complex for inversion was quantified using a range of motion apparatus. The inversion path of motion for the foot and the shoe was quantified using a high speed video system. The results of this study indicated: (a) Comprehensive functional tests of ankle joint braces using ROM and POM measurements showed maximal group differences of less than 1 degree between days for ROM (rAROM = 0.96 and rPROM = 0.93) and less than 1.5 degrees for POM measurements (rPOM = 0.88). (b) PROM measurements showed a consistent "creep" effect of about 2 degrees with increasing trial number during the first ten trials which must be taken into consideration for the design of the appropriate test protocol. (c) The correlation coefficient between AROM and POM was 0.37 and 0.44 between PROM and POM, suggesting that AROM and PROM measurements do not predict inversion during actual movement.