Empowering Rural Housewives in Iran: Utilizing the Transtheoretical Model to Increase Physical Activity.

OBJECTIVES: Rural housewives are integral to household management and family care, yet their sedentary lifestyles present significant health risks. This study used the transtheoretical model (TTM) to investigate strategies that encourage and maintain regular exercise habits among rural housewives. METHODS: A semi-experimental study was conducted in 2021 with 114 housewives aged 30 to 59 who attended rural health centers in Gorgan, Iran. Participants were randomly assigned to 1 of 2 groups. Data collection involved a validated questionnaire that gathered demographic information and constructs of the TTM. The intervention group participated in a comprehensive educational program, which included four 60-minute sessions. Data were collected again 6 months post-intervention and analyzed using descriptive and inferential statistics in SPSS version 21. RESULTS: The study encompassed women with an average age of 39.75±6.05 years, the majority of whom had educational levels below a diploma, and over 90% were married. We observed strong correlations between the processes of change, self-efficacy, and decisional balance. At the outset, there were no significant differences in demographics or model structures between the 2 groups. However, 6 months post-intervention, the intervention group exhibited statistically significant differences in the mean scores of model structures, stages of change, and body mass index (<>p<0.05). CONCLUSIONS: This study highlights the importance of physical activity training for rural housewives. The findings suggest that the educational intervention, which utilized the TTM, significantly impacted the participants' model structures and their stages of change.

The impact of the digital economy on industrial structure upgrading in resource-based cities: Evidence from China.

The digital economy provides a new path to promote industrial structure upgrading. Using panel data from 2011 to 2020 for 85 resource-based cities in China, this paper empirically investigates the impact of the digital economy on industrial structure upgrading and the primary mechanism. The results show that the digital economy is conducive to promoting industrial structure upgrading in resource-based cities, and innovation is the primary mechanism of action. According to the different stages of resource development, we classify resource-based cities into growth, maturity, decline, and regeneration cities, and we further analyze the heterogeneous influence. In terms of influence degree, the digital economy has a more prominent role in promoting industrial structure upgrading in resource-exhausted cities. In addition, we also found that the closer to the provincial capital city, the more pronounced the promotion of the digital economy to the industrial structure upgrading.

Effectiveness of health education and counseling on stages of change, decisional balance, and smoking cessation self-efficacy: A prospective self-control study.

OBJECTIVE: To examine the effectiveness of health education and counseling on the stages of change, decisional balance, and smoking cessations elf-efficacy in smokers with no intention of quitting. METHODS: A prospective self-controlled design was conducted between December 2020 and December 2022. The research period was divided into a control stage (first to fourth weeks) and an experimental stage (fifth to eighth weeks). Patients with coronary artery disease (CAD) and habitually smoked were recruited. Pearson correlation and a one-factor repeated-measurement analysis were performed to assess the effectiveness of the intervention. RESULTS: In total, 108 male CAD patients with a mean age of 58.1 years were recruited. After 4 weeks of the intervention, 55 (51%) exhibited behavior change (X 2 = 18.03, p = .001). The decisional balance and smoking cessation self-efficacy scores significantly improved in the experimental stage. No significant differences were observed in the control stage. CONCLUSIONS: Four weeks of health education and counseling could effectively improve participants' stage of change, decisional balance, and smoking cessation self-efficacy. PRACTICE IMPLICATION: Healthcare professionals can play key roles in helping CAD patients successfully quit smoking through individual education and counseling.

The effectiveness of a transtheoretical model-based smoking cessation intervention for rural smokers: A quasi-experimental longitudinal study.

OBJECTIVE: Cigarette smoking is highly prevalent, despite being a primary preventable cause of disease and mortality. This study examined the effect of a Transtheoretical Model (TTM)-based psychoeducational intervention for smoking cessation (SC) on knowledge, SC-related parameters, and progression through the TTM stages of change among rural smokers. METHODS: This quasi-experimental study recruited 200 smokers from an outpatient clinic. The comparison group was recruited before the experimental group to address possible self-selection bias. Structured questionnaires were administered pre- and post-intervention (three months) and at follow-up (six months). RESULTS: A generalised estimation equation model indicated that the TTM-based intervention significantly increased participants' SC-knowledge and improved progression through TTM stages by the six-month follow-up. No significant group differences were found in self-efficacy and nicotine dependence scores or daily cigarette consumption. CONCLUSIONS: A TTM-based intervention enhances SC-knowledge and fosters progress through change stages. However, it does not directly impact nicotine dependence or cigarette consumption. Outpatient settings may employ TTM-based programmes for SC education and motivation. Detecting anticipated effects may require a longer intervention duration exceeding six months. PRACTICE IMPLICATIONS: Such TTM-based programmes may facilitate SC-knowledge and motivation in outpatient settings. Further research to comprehend patients' context and experiences during the stages of change is required.

Effects of driving style on takeover performance during automated driving: Under the influence of warning system factors.

Driving style has been proposed to be a critical factor in automated driving. However, the role of driving style in the process of taking over during automated driving needs further investigation. The main purpose of this study was to investigate the influence of driving style on takeover performance under the influence of warning system factors. In addition, this study also explored whether the impact of driving style on reaction time varies over time and the role of driving style on a comprehensive takeover quality indicator. Two driving simulation experiments with different takeover request (TOR) designs were conducted. In experiment 1, content warning information was provided in the TOR with different warning stage designs; in experiment 2, countdown warning information was provided in the TOR with different warning stage designs. Sixty-four participants (32 for experiment 1 and 32 for experiment 2) were classified into two groups based on their driving style (i.e., aggressive, or defensive) using the Chinese version of the Multidimensional Driving Style Inventory (the brief MDSI-C). The results suggested that drivers' driving style had significant effects on takeover performance, but the effects were influenced by warning system designs. Specifically, defensive participants performed better takeover performance, i.e., shorter reaction time and cautious vehicle control behaviors, than aggressive participants in most warning conditions. The content and countdown warning information and warning stage design affected the roles of driving style on takeover performance: 1) compared to the one-stage warning design, the two-stage warning design significantly shortened the reaction time of the participants with different driving styles, 2) compared to the countdown warning information design, the design of content warning information can shorten the reaction time of aggressive participants and lengthen the reaction time of defensive participants in the two-stage warning conditions, and 3) compared to the content warning information design, countdown warning information can improve the safe takeover performance of defensive participants. This study provides a better understanding of the role of driving style on takeover performance, and driving style should be considered when designing warning systems for autonomous vehicles.

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.

Transtheoretical Model for Exercise: Measure Redevelopment and Assessing the Role of Barriers in a Diverse Population.

PURPOSE: To redevelop and improve Transtheoretical Model (TTM) exercise measures for Black and Hispanic/Latinx adults. The redeveloped scales will address barriers to exercise potentially relevant to populations of color in the United States (US). DESIGN: Cross-sectional, split-half measure development. SETTING: Online survey in the US. SUBJECTS: 450 Black and/or Hispanic/Latinx adults. MEASURES: Demographics, exercise engagement (IPAQ-SF), stage of change (SOC), decisional balance (DCBL), self-efficacy (SE), and barriers to exercise. ANALYSIS: Split-half exploratory (EFA) and confirmatory factor analyses (CFA) were executed to establish measurement structure and fit, followed by multivariate analyses to assess constructs by SOC. RESULTS: EFA/CFA for DCBL revealed three factors (α = .85, .70, .75) which represented Pros of exercise, Cons of exercise related to time and safety, and Cons of exercise related to physical or emotional discomfort. Model fit was adequate (CFI = .89). For SE, two factors (α = .85, .77) resulted with good model fit (CFI = .91). These factors reflected self-efficacy to exercise when confronted with generally challenging situations, and self-efficacy to exercise when specifically experiencing affective difficulties, such as depression or anxiety. Lastly, a novel Barriers measure resulted in three factors (α = .82, .77, .76), representing barriers encountered due to family responsibilities, work obligations, and health challenges, with good model fit (CFI = .95). Shifts in the core TTM constructs by SOC largely mapped onto the theoretical trends expected under the TTM. CONCLUSION: This study produced systematically developed TTM exercise measures for Black and Hispanic/Latinx adults in the US that address and incorporate important barriers to exercise. This research represents an important step forward in broadening the inclusion of diverse populations to TTM measure development processes and may lead to a better understanding of relevant factors impeding exercise engagement in the US.

Cigarette Smoking Motives and Stages of Change in Smoking Cessation Among Veterans: Differences by Gender and Sexual Orientation.

PURPOSE: To examine differences across gender and sexual orientation in cigarette smoking motives and stages of change in smoking cessation among Veterans. DESIGN: Secondary data analysis of cross-sectional baseline surveys from a prospective cohort study. SETTING: United States, self-administered online survey. PARTICIPANTS: Cisgender Veterans who reported past-year smoking (N = 146); 66.4% identified as lesbian, gay, or bisexual and 52.1% were men. MEASURES: Smoking motives (i.e., social, self-confidence, boredom relief, and affect regulation), with higher scores indicating stronger motivation to smoke. Stages of change categories included precontemplation, contemplation/preparation, and action/maintenance. ANALYSIS: Analyses were stratified by gender and sexual orientation. Age-adjusted linear regression models estimated differences in smoking motives scores and multinomial logistic regression models estimated differences in stages of change categories relative to the precontemplation stage (reference category). RESULTS: In this Veteran sample, gay men reported higher social smoking motives vs heterosexual men (ß = 1.50 (95% CI: .04, 2.97), P-value = .045) and higher boredom relief smoking motives vs bisexual men (ß = 1.53 (95% CI: .06, 2.29), P-value = .041) in age-adjusted models. Lesbian women were more likely to be in the action/maintenance stage relative to the precontemplation stage when compared to both heterosexual women (aRRR = 4.88 (95% CI: 1.00, 23.79) P-value = .050) and bisexual women (aRRR = 16.46 (95% CI: 2.12, 127.57), P-value = .007) after adjusting for age. CONCLUSION: Smoking cessation interventions may benefit from enhancing peer support for gay men. Given bisexual and heterosexual women were in less advance stages of change, there may be a greater need for motivational interventions to encourage quitting and additional support to assist with cessation efforts. Overall, findings highlight the diversity of cigarette use within LGB communities.

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.

Breast Cancer Knowledge and Mammography Use Among Asian American Women Aged 40 and Older: Using the Transtheoretical Model Approach.

Mammography screening rates remain low among Asian American women (AAW). The aims of our study were to: (a) assess breast cancer knowledge and mammography screening behaviors, and (b) identify the factors related to the transtheoretical model (TTM) stages of change in relation to mammography utilization among AAW aged 40 and older. Using a cross-sectional design, a convenience sample of 714 AAW completed a structured questionnaire in 2021. Participants demonstrated a moderate level of knowledge regarding breast cancer and mammography. Only 34.2% of the participants reported obtaining regular mammograms. The ordinal logistic regression indicated that age, birthplace, health perception, breast biopsy history, breast cancer knowledge, self-efficacy, and perceived barriers were correlated with TTM stages of change. Our results highlight the need for implementing effective interventions aimed at increasing knowledge and screening rates for breast cancer among AAW. Additional TTM studies with AAW are needed to determine the relationships among TTM constructs and develop theory-based programs to improve adherence to screening guidelines. Future research using a mixed-method design may provide opportunities to explore complex phenomena associated with breast cancer screening behaviors. Finally, further assessments of the Breast Cancer Knowledge Scale's psychometric properties are necessary to improve this instrument.

Consumer engagement with sustainable wine: An application of the Transtheoretical Model.

Sustainable wine is an important emergent wine category for which there is limited research on levels of consumer engagement and the multifaceted drivers of that engagement. Here, I extend prior research largely limited to organic wine, and apply the Transtheoretical Model of Behavioural Change (TTM) for the first time to determine consumer engagement around eight sustainable wine behaviours, and the role of purchase motivators, wine involvement and demographic factors in predicting those behaviours. The online survey of 727 Canadian wine consumers determined the action stage for each sustainable wine behaviour (precontemplation, contemplation, preparation, or action), and multinomial logistic regressions assessed the drivers of both action and inaction (precontemplation). Results show that most consumers are in a change stage with respect to sustainable wine behaviours (i.e., contemplation or preparation), suggesting the need for both education and sustainable certification initiatives. Generally, neither gender, income, province of residence, education nor the importance of price in wine purchase decisions associated with action stage for behaviours. In contrast, wine involvement and the importance of sustainability cues in wine purchase were the strongest and most consistent predictors of both action and inaction, while age and the importance of both taste expectation and perceived quality were predictive for some behaviours. I conclude that TTM is a very useful construct for assessing the nuances of consumer behaviour toward sustainable products, and the findings provide guidance for stakeholders interested in promoting greater sustainability in the wine industry through influencing consumer choice behaviour.

Heavy-tailed distributions of confirmed COVID-19 cases and deaths in spatiotemporal space.

This paper conducts a systematic statistical analysis of the characteristics of the geographical empirical distributions for the numbers of both cumulative and daily confirmed COVID-19 cases and deaths at county, city, and state levels over a time span from January 2020 to June 2022. The mathematical heavy-tailed distributions can be used for fitting the empirical distributions observed in different temporal stages and geographical scales. The estimations of the shape parameter of the tail distributions using the Generalized Pareto Distribution also support the observations of the heavy-tailed distributions. According to the characteristics of the heavy-tailed distributions, the evolution course of the geographical empirical distributions can be divided into three distinct phases, namely the power-law phase, the lognormal phase I, and the lognormal phase II. These three phases could serve as an indicator of the severity degree of the COVID-19 pandemic within an area. The empirical results suggest important intrinsic dynamics of a human infectious virus spread in the human interconnected physical complex network. The findings extend previous empirical studies and could provide more strict constraints for current mathematical and physical modeling studies, such as the SIR model and its variants based on the theory of complex networks.

The Transtheoretical model's processes of change in the heart of a physical activity intervention: A series of n-of-1.

The objectives were a) to test whether a Processes of Change (POC)-personalized Transtheoretical model (TTM)-based intervention could increase physical activity (PA) among inactive adults, and b) to examine whether the intervention increased the level of TTM theoretical constructs. The following hypotheses were formulated: 1) PA levels will be significantly higher during and after the intervention in comparison to baseline measures; 2) the level of targeted POCs will increase during the intervention; 3) non targeted POCs will stay stable, and 4) self-efficacy and decisional balance levels will increase during the intervention. A series of N-of-1 with A (1 to 2-week)-B(10-week)-A'(2-week) design were conducted with 12 inactive adults. Behavioral counselors used behavior change techniques to target TTM constructs and supervise PA. Interventions were individualized based on the 5 POCs with the lowest pre-intervention level. Device-based and subjective PA along with TTM measures were collected weekly online. PA data were analyzed with piecewise linear models. A visual analysis was run to examine the TTM constructs. Device, self-reported and TTM data were available for five, seven and five participants, respectively. A significant self-reported PA increase for six participants was found during the phase B and A2. A significant device-measured PA increase was observed in two participants during the study. A substantial increase of targeted POC from baseline for all participants with available data was observed. This study provides the first evidence of behavioral and psychological effects of a POC-personalized TTM-based intervention in inactive adults.

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.

Measuring Motivation for COVID-19 Vaccination: An Application of the Transtheoretical Model.

PURPOSE: In the United States (US), individuals vary widely in their readiness to get vaccinated for COVID-19. The present study developed measures based on the transtheoretical model (TTM) to better understand readiness, decisional balance (DCBL; pros and cons), self-efficacy (SE), as well as other motivators for change such as myths and barriers for COVID-19 vaccination. DESIGN: Cross-sectional measurement development. SETTING: Online survey. SAMPLE: 528 US adults ages 18-75. MEASURES: Demographics, stage of change (SOC), DCBL, SE, myths, and barriers. ANALYSIS: The sample was randomly split into halves for exploratory factor analysis using principal components analysis (EFA/PCA), followed by confirmatory factor analyses (CFA) to test measurement models. Correlation matrices were assessed and multivariate analyses examined relationships between constructs and sub-constructs. RESULTS: For DCBL, EFA/PCA revealed three correlated factors (one pros, two cons) (n1 = 8, α = .97; n2 = 5, α = .93; n3 = 4, α = .84). For SE, two correlated factors were revealed (n1 = 12, α = .96; n2 = 3, α = .89). Single-factor solutions for Myths (n = 13, α = .94) and Barriers (n = 6, α = .82) were revealed. CFA confirmed models from EFAs/PCAs. Follow-up analyses of variance aligned with past theoretical predictions of the relationships between SOC, pros, cons, and SE, and the predicted relationships with myths and barriers. CONCLUSION: This study produced reliable and valid measures of TTM constructs, myths, and barriers to understand motivation to receive COVID-19 vaccination that can be used in future research.

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.

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.

LiteGaze: Neural architecture search for efficient gaze estimation.

Gaze estimation plays a critical role in human-centered vision applications such as human-computer interaction and virtual reality. Although significant progress has been made in automatic gaze estimation by deep convolutional neural networks, it is still difficult to directly deploy deep learning based gaze estimation models across different edge devices, due to the high computational cost and various resource constraints. This work proposes LiteGaze, a deep learning framework to learn architectures for efficient gaze estimation via neural architecture search (NAS). Inspired by the once-for-all model (Cai et al., 2020), this work decouples the model training and architecture search into two different stages. In particular, a supernet is trained to support diverse architectural settings. Then specialized sub-networks are selected from the obtained supernet, given different efficiency constraints. Extensive experiments are performed on two gaze estimation datasets and demonstrate the superiority of the proposed method over previous works, advancing the real-time gaze estimation on edge devices.

Behavioral change stage might moderate the impact of multifaceted interventions on non-attendance from medical care among patients with type 2 diabetes: The Japan Diabetes Outcome Intervention Trial-2 Large-Scale Trial 007 (J-DOIT2-LT007).

AIMS/INTRODUCTION: Non-attendance from regular medical care is a major problem in diabetes patients. This study aimed to examine the impact of a multifaceted lifestyle intervention by face-to-face approach (FFA) on non-attendance from regular medical care in comparison with that by telephone from the technical support center (TSC). MATERIALS AND METHODS: This was secondary analysis from a 1-year, prospective, cluster randomized, intervention study. Patients with type 2 diabetes, who were regularly visiting primary care physicians cluster-randomized into the control or intervention (TSC or FFA according to resource availability of the district medical associations) groups, were consecutively recruited. The primary end-point was non-attendance from regular medical care. The interaction between the type of intervention (TSC vs FFA) and behavioral change stage (pre- vs post-action stage) in diet and exercise for the dropout rate was assessed. RESULTS: Among the 1,915 participants (mean age 56 ± 6 years; 36% women) enrolled, 828, 564 and 264 patients belonged to the control, TSC and FFA groups, respectively. We found evidence suggestive of an interaction between the intervention type and behavioral change stage in diet (P = 0.042) and exercise (P = 0.038) after adjusting for covariates. The hazard ratios (95% confidence interval) of FFA to TSC were 0.21 (0.05-0.93) and 7.69 (0.50-117.78) in the pre-action and post-action stages for diet, respectively, whereas they were 0.20 (0.05-0.92) and 4.75 (0.29-73.70) in the pre-action and post-action stages for exercise. CONCLUSIONS: Among diabetes patients, the impact of multifaceted intervention on non-attendance from medical care might differ by the behavioral change stage.

The effect of motivational interviewing based on the transtheoretical model on oral cleaning behavior of patients with periodontitis who have undergone implant restoration.

BACKGROUND: Implant-restored patients with periodontitis have a higher risk of developing peri-implantitis, and helping them develop oral cleaning habits is significant. OBJECTIVE: To evaluate the effectiveness of motivational interviewing based on the transtheoretical model on the modification of oral cleaning behaviors of implant-restored patients with periodontitis. METHODS: Patients with periodontitis (n= 70) who would receive dental implant treatment were included. And they were randomly divided into two groups: experimental (n= 35) and control (n= 35). Control patients received routine oral hygiene education, and those in the experimental group received motivational interviewing based on the transtheoretical model. Oral cleaning behavior was compared between the two groups before and after intervention. In addition, periodontal health status was compared on the day of implant restoration and three months later. RESULTS: Compared to the control, the experimental group demonstrated significantly better oral hygiene behavior after intervention (P< 0.05). Three months after implant restoration, significantly better results were obtained by the experimental group in terms of mPLI and mSBI (P< 0.05). CONCLUSION: Motivational interviewing based on the transtheoretical model can effectively improve the oral cleaning behavior and periodontal health of implant-restored patients with periodontitis.