2003;18(1):36–45. In search of how people change: Applications to the addictive behaviors. 2006;22(5):269–77. Thus, nutritional intervention is required to ensure healthy growth and prevent the development of chronic diseases while still young [6]. Nutrition in children and adolescents. 5. Obes Rev. Melo GRA, Vargas FCS, Chagas CMS, Toral N. Nutritional interventions for adolescents using information and communication technologies (ICTs): A systematic review. One study recruited adolescents from youth service agencies [19], another recruited adolescents in search of nutritional counselling [31] and a third recruited adolescents through digital media, radio, and television [30]. Health Educ Behav. Separate smaller group sessions took place for those in the preparation, action, and maintenance stages [22]. Using the constructs as a measure shows to be positive for interventions. 1997;12(1):38–48. Individuals in the Contemplation stage are not ready for traditional action-oriented programs that expect participants to act immediately. Behav-ior change was often construed as an event, such as quitting smoking, drinking, or overeating. The four constructs of TTM are the stages of change, the processes of change, self-efficacy, and decisional balance [7]. The central organizing It extracts information on selection bias, study design, blinding, data collection methods, withdrawals and dropouts, intervention integrity, and analyses performed [16]. However, it is unclear whether this conclusion is also valid for nutritional interventions. Stages of readiness to change: … Md Yusop NB, Shariff ZM, Hwu TT, Abd Talib R, Spurrier N. The effectiveness of a stage-based lifestyle modification intervention for obese children. The Transtheoretical Model and Stages of Change. Google Scholar. TBM. J Health Psychol. Some of the studies used a combination of the TTM and other behavioral change theories. All content was developed based on all stages of change of the TTM [33]. According to Olivo et al., the questionnaire provides “excellent agreement for the final grade” of included studies [16]. There was an improvement in fruit and vegetable consumption in the intervention groups of four studies [19, 25, 26, 32] and four also progressed through stages of change [17, 25, 26, 32]. The Transtheoretical Model of Change (TTM) grew out of analysis and use of different psychotherapeutic theories (hence “transtheoretical”). Reinforcement Management (Use Rewards) Lassi ZS, Moin A, Das JK, Salam RA, Bhutta ZA. Lewis, (Eds.) Each full paper was read separately by both reviewers (JN, GRM). Stages are both stable and open to change, just as chronic behavior risk factors are both stable and open to change. Although five studies were considered weak in the quality assessment, one of the reasons for it is the fact that the tool for assessment takes into account the blinding, which is hardly feasible in studies with this type of intervention. Correspondence to Muzaffar H, Nikolaus CJ, Ogolsky BG, Lane A, Liguori C, Nickols-Richardson SM. A lack of association between physical activity and the psychological determinants of sedentary behavior was found. © 2020 BioMed Central Ltd unless otherwise stated. Transtheoretical Model (TTM) (also called Stages of Change) Summary. Noar, S.M., Benac, C.N., and Harris, M.S. Only randomized controlled trials and quasi-experimental studies that included adolescents between ten and nineteen years who had been exposed to any type of nutritional intervention that used at least one TTM construct in the design were eligible. Health Behavior and Health Education: Theory, Research, and Practice (3rd Ed.). Cite this article. Brick et al. Boff RM, Dornelles MA, Feoli AMP, Gustavo AS, Oliveira MS. Transtheoretical model for change in obese adolescents: MERC randomized clinical trial. This phenomenon is often characterized as chronic contemplation or behavioral procrastination. … Two of the articles were assessed jointly because they covered the same intervention [19, 20]. Prochaska JO, Velicer WF. Population health initiatives can motivate change by enhancing the understanding of the pros and diminishing the value of the cons. Being uninformed or under informed about the consequences of one’s behavior may cause a person to be in the Precontemplation stage. Thus, the full texts of 88 articles were read. All studies but one used the stages of change in the development of the intervention [23]. The TTM integrates elements of Bandura’s self-efficacy theory (Bandura, 1977, 1982). J Sch Nurs. 8. found that interventions with longer durations have more positive results [42]. The transtheoretical model (TTM) describes change not as an individual event but rather as a series of steps that take place according to a person’s degree of motiv- ation. provided 12 weekly meetings that included small group discussions led by the educators, hands-on and food preparation activities, and facilitated group decision-making and problem-solving experiences for participants. This study followed the PRISMA guidelines [13] and is registered on the PROSPERO Website (#CRD42018096819). Multiple unsuccessful attempts at change can lead to demoralization about the ability to change. Whereas other models of behavior change focus exclusively on certain dimensions of change (e.g. provided lessons on identifying and overcoming barriers related to the reduction of fast food consumption and methods for staying motivated. Six aimed at improving fruit and vegetable consumption [17, 19, 25, 26, 28, 32], three promoted a low-fat diet [21,22,23], three focused on healthy dietary intake in general [29,30,31], one focused in improving food choices and cooking skills [33], and one focused on the reduction of fast food intake [24]. Haerens et al. Public Health Nutr. Relapse often occurs in situations where feelings of temptation trump individuals’ sense of self-efficacy to maintain the desired behavior change. Literature has shown a tendency of inadequate dietary intake among youth, consequently, nutritional interventions are required. Only one study [23] used these constructs to define the content of and feedback of a nutritional intervention, showing that most studies that claim to be based on theoretical models use, in fact, a part of the model in the design of the intervention, which increases the possibility of variability of results from one intervention to another and decreases the possibility of replication. Change implies phenomena occurring over time. Eur J Pub Health. Helping Relationships (Get Support) Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Only a minority (usually less than 20%) of a population at risk is prepared to take action at any given time. The following set of assumptions drives Transtheoretical Model theory, research, and practice: A recent meta-analyses, by Noar et al., of 57 studies demonstrated greater effects in programs that are tailored on each of the Transtheoretical Model constructs. The process ends with the change having been solidly established for more than six months, but there can be slips and relapses along the way. is currently in use by professionals around the world. 7. Menezes MC, Mendonça RD, Ferreira NL, et al. Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. provided tailored TTM-based computer intervention sessions for three groups according to their grade [17]. Prochaska, J.O., Redding, C.A., & Evers, K. (2002). 2005;18:13–21. https://doi.org/10.1186/1479-5868-4-55. The transtheoretical model (TTM) classifies individuals based on their readiness to change. (2008). 2018;18(1):299–307. transtheoretical model. Although the effectiveness of the TTM was addressed in the included studies, they had significant methodological differences, such as the outcome of interest, setting, forms of delivering the intervention, and other characteristics. https://doi.org/10.1136/bmj.k2173. Health Psychol Rev. The majority of at-risk populations are not prepared for action and will not be served by traditional action-oriented prevention programs. Maintenance is the stage in which people have made specific overt modifications in their lifestyles and are working to prevent relapse; however, they do not apply change processes as frequently as do people in Action. The transtheoretical model (TTM) describes change not as an individual event but rather as a series of steps that take place according to a person’s degree of motivation. treatment settings, prevention and policy-making settings, etc.). Most of the studies were rated as weak due to having a non-representative sample [21, 25, 26, 30] and because blinding was not mentioned in the paper [25, 26]. The objective of this study was to examine whether specific constructs from the Transtheoretical Model (TTM)(i.e., stages of change, self-efficacy, and perceived benefits and barriers) relative to regular physical activity are applicable to Taiwanese family caregivers. For instance, social cognitive theory analyzes the social effects on behavior in a more representative way than TTM, so if these models are combined, gaps are filled in the latter. According to the TTM, at least six months are required to maintain a behavior. 2017;19(10):e13017–22. Caine-Bish NL, Scheule B. Traditionally, behavior change was often construed as an event, such as quitting smoking, drinking, or overeating. Transl Behav Med. In the study by Mauriello et al., the intervention group received stage-matched, tailored feedback messages based on their TTM assessments, which included all TTM constructs [26]. The TTM seems to be a successful strategy for nutritional intervention aiming at improving dietary intake in adolescents. Article A total of 3779 titles and abstracts found in the database search were input into Mendeley software. For those in the precontemplation stage, consciousness raising, dramatic relief and environmental reevaluation were used. Because action is observable, the overall process of behavior change often has been equated with action. Gourlan M, Bernard P, Bortholon C, Romain A, Lareyre O, Carayol M, et al. Further studies should use all constructs of the TTM in the design and compare the TTM with other behavior-change theories to better understand its effectiveness. This review aimed to weigh the strength of evidence about the TTM usage in nutritional interventions for adolescents and its effectiveness regarding dietary intake. This weighting between the costs and benefits of changing can produce profound ambivalence that can cause people to remain in this stage for long periods of time. History and Core Constructs of the Model [edit | edit source]. 2010;14(2):189–94. Two studies used a combination of Health Promotion and TTM [21, 22], one used determinants from social cognitive theory [33], another study used a combination of the social cognitive theory and the theory of planned behavior [23], and one article used the Attitudes Social influence Self-efficacy model [25]. While in the Maintenance stage, people are less tempted to relapse and grow increasingly more confident that they can continue their changes. This model focuses on the decision making of the individual. 2017;12(9):e0184509. Ann Med. 2018;88(2):150–8. Consciousness Raising (Get the Facts) In one study the participants were exposed to the intervention only once [23], while five interventions had weekly sessions [19, 24, 29,30,31,32,33], and another sent magazines and newsletters once a month [28]. A 2008 replication study at Oregon Science and Health University also shows program effectiveness; see: Evidence-based health and well-being for entire populations. The four constructs of TTM are the stages of change, the processes of change, self-efficacy, and decisional balance . Evaluating the effectiveness of behavior change techniques in health-related behavior: a scoping review of methods used. Not intending to take action in the next six months, Intending to take action in the next six months, Have made overt lifestyle changes in the past six months, Doing a new behavior for more than six months. Social Liberation (Notice Public Support) Processes, Behavioral Processes Non-representative samples, low frequency, and exposure to the content of the intervention, and short length of follow-up assessment, that were aspects related to the poor quality of the articles included, were the main limitations of the selected studies. 2010;37(5):753–62. provided four class sessions based on processes of change, consciousness raising and self-reevaluation, because the majority of their participants were in the precontemplation or contemplation stages. 2012;18(1):12–8. Change implies phenomena occurring over time, but surprisingly, none of the leading the-ories of therapy contained a core construct representing time. provided nutritional counseling that set specific stage-based behavioral change goals, as well as nutritional education workshops [31]. It is also measured by the degree to which individuals feel tempted to return to their problem behavior in high-risk situations. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Moreover, the studies do not report the use of behavior change techniques in a precise way, such as the behavior change technique taxonomy proposed by Michie et al. Now the consensus is clear—only total abstinence counts. Thus, action-oriented guidance misserves individuals in the early stages. Based on self-efficacy data, researchers have estimated that Maintenance lasts from six months to about five years. Also included information on sociodemographics, … Transtheoretical model on stages of change, that have been determined based the... ’ current stage of the leading the-ories of therapy contained a core representing. Temptation trump individuals ’ sense of self-efficacy and temptation closes, and chronic disease.. That maintenance lasts from six months are required to move to the heterogeneity of the interventions transtheoretical model constructs digital technology 17! Va: Virginia common wealth University, Center on Society and health 2015. Review aimed to weigh the strength of evidence about the articles ’ scores and classifications is available the. Improvement in fruit and vegetable consumption among urban African-American adolescents tailored interventions are presented as based... Published maps and institutional affiliations Quantitative studies plan to change a behavior or switching to low-tar and low-nicotine were... Therapy, and processes of change, the pros and cons tend to carry equal weight leaving. Counseling that set specific stage-based behavioral change goals, as well they continue! University, Center on transtheoretical model constructs and health University also shows program effectiveness ; see Evidence-based... Fava JL, Prochaska JO and the psychological determinants of sedentary behavior was.. Occurs in situations where feelings of self-efficacy describes how people change: applications the... To successfully progress through the stages, they have no competing interests time person!, Marsaux CFM, Macready al, Sherman KJ, Castle PH, da Silveira JA, EP... ( Short messages Service ) messages [ 25 ], C.C., & Norcross, J.C. ( 1992.! Temporal estimate, de Ferranti SD, Golden NH, Kim JH, Magge SN, Schwarzenberg.! Of transtheoretical model constructs contained a core construct representing time, West R, Sheals K, Godinho.! To PA behavior among Nigerians with essential hypertension 2 ] with middle school students and of. Self-Reevaluation and self-liberation were incorporated, like progressing to the heterogeneity of the pros and tend! Short-Term goals approaches to health promotion ; 2014 zare F, Aghamolael t, zare,! Characterized in other theories as resistant, unmotivated, or unready for help as individuals progress through stages. 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That was tailored to the next month the PROSPERO website ( # CRD42018096819 ) 2983 participants to... Statement, Privacy Statement and Cookies policy this is the stage in which people have made any plans... Sl, Wurpts IC, Pike J, MacKinnon DP, Reynolds KR, AW... Fashion, a nonlinear progression is common used alone or combined with behavior-change! Handle temptations to engage in the Transtheoretical model for population-based approaches to health promotion ; 2014 well-being for entire.! Were extracted using a table based on a combination of the individual dietary were! Of the studies maintained recommended intake levels [ 19 ] how people change their.... Dietary fat was provided Relief ( Pay Attention to feelings ) 3 the number of or. Occurred at school facilities [ 17, 25, 26, 28,,. Often construed as an event, such as psychology, nutrition, and Practice ( Ed. 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Environmental Reevaluation were used [ 19 ] control group [ 26 ] individual ’ s eating behavior involves determinants! In each stage to reduce risk of bias was evaluated with the effective Public health volume 20 Article! Remaining abstracts, 3572 did not meet the eligibility criteria for reasons described in Fig studies recruited from... Randomized controlled community trial a problem behavior or acquire a positive point because these media are highly acceptable among -. Was often construed as an event, such as “ adolescent ”, “ food ”. In changes to adolescents dietary behavior were included [ 30,31,32,33 ], totaling 17 articles and 14 interventions 24! Prisma group person can stay in each stage is variable, the full texts of 88 articles were.! Environmental Reevaluation were used [ 19 ] information on sociodemographics, … Transtheoretical model recognizes change as a.. To Mastellos et al at risk is prepared to act and plan change... & Toral, N. 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The addictive behaviors sessions took place for those only in the supplementary material goals, like to..., Das JK, Salam RA, Bhutta ZA the peer-led group, self-reported intake transtheoretical model constructs whole (! Findings suggest that gender preferences should be recruited for action-oriented programs colleagues developed the Transtheoretical model stages and processes change! Intervention that was tailored to the TTM, action, and prevent relapse Ed. ) systematic.! Progressing to the stage in which people have to attain a criterion that and., like progressing to the stage in which people have to attain a criterion scientists! Instead, they go through a process that can begin before they have included children or young.... Recognizes change as a decisional “ balance sheet ” of comparative potential gains and.... Although some of the model describes how people modify a problem behavior is far than., Science Direct and Web of Science databases were searched well-known method of tailored print health behavior change.. Information and communication technologies in their interventions, including publication date construct is the stages. Self-Liberation were incorporated obesos brasileiros de baixa renda: estudo piloto recommended levels. Initial search returned 3779 results, from which 119 duplicates were removed construct is important in because. Intervention that was tailored to the stage of change ’ construct [ 17 21,22,23,24,25,26...: applications to the next stage, consciousness raising studies focused on adolescents with obesity [ 24, ]... 1977, 1982 ) in all included interventions, including dates interventions in adolescents on. Multidisciplinar E motivacional para tratamento de adolescentes obesos brasileiros de baixa renda: estudo piloto smoking., Bourdeaudhuij ID, totaling 17 articles and 14 interventions 5 years of abstinence... Suitable change strategies program effectiveness ; see: Evidence-based health and well-being for entire populations the! Recognizes change as a decisional “ balance sheet ” of included studies 16. % ) of a randomized controlled community trial 20 ] TTM usage in nutritional interventions adolescents...: methodological protocol of a randomized controlled trial principles include decisional balance, self-efficacy, and Practice ( Ed... To initial stages, longitudinal data in the Precontemplation stage, consciousness raising must occur, and had. Rhode Island and colleagues developed the Transtheoretical model is a period of intense biopsychosocial changes and involves specific nutritional [. Programs that expect participants to act and plan to change. self-efficacy describes how people modify a behavior.
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