Dietary Applications of the Stages of Change Model

https://doi.org/10.1016/S0002-8223(99)00164-9Get rights and content

Section snippets

Stages of Change and Dietary Behaviors

Stage of change is the temporal dimension of motivational readiness to change a health behavior. Several stages compose the dimension: precontemplation (no intention of changing in the foreseeable future, usually defined as the next 6 months), contemplation (intending to change, but not soon), preparation (intending to change in the next month), action (recent change), and maintenance (maintaining change for at least 6 months). Stage defines when change occurs and can be used in interventions

Processes of Change

The Transtheoretical Model originated from an analysis of 18 systems of psychotherapy that identified common processes of change (32). Processes are the covert and overt activities that people use to progress through the stages; they are how people change (see Table 2). Experiential processes focus on thoughts, feelings, and experiences, whereas behavioral processes focus on behaviors and reinforcement. In a 2-year observational study of self-change for smoking cessation, the processes of

Decisional Balance

Decisional balance measures the balance or relative importance to the individual of the pros (advantages or benefits) and the cons (disadvantages, barriers, or costs) of change. Decisional balance is derived from the model of decision making of Janis and Mann (35); however, when tested empirically, the proposed 8-factor model was found to have only 2 factors (pros and cons) (36). Prochaska and colleagues (37) found the 2-factor model was replicated for 12 health behaviors, including dietary fat

Situational Self Efficacy or Temptation

The self-efficacy construct represents situation-specific confidence people have that they can engage in the desired behavior change (40). This construct was adapted from the self-efficacy theory of Bandura (41). The converse of self-efficacy is situation-specific temptation (how tempted a person feels to eat high-fat foods in different situations). Both self-efficacy and temptation have the same measurement structure with 3 distinct factors, that is, positive social, negative affect, and

Interventions Based on the Model

The Transtheoretical Model provides a theoretical framework for approaches to accelerate the rate of behavior change in a population. At any given moment, only one quarter of the population is ready to take meaningful action to change a health behavior. Approximately half of those with problems are in the precontemplation stage of change, a stage marked by denial and resistance to change. Most interventions, however, are action oriented. This may explain the marked success found in studies such

Applications

In addition to the advantages described of applying the Transtheoretical Model to public health interventions, the model has potential for individual interventions by health care practitioners. Even in individual applications, it is important to use all dimensions of the model rather than relying on the stages alone for intervention design.

It would be counterproductive to provide action-oriented material about dietary change behaviors, avoiding temptation, or use of behavioral processes to

First page preview

First page preview
Click to open first page preview

References (46)

  • J.O. Prochaska et al.

    Common processes of change for smoking, weight control, and psychological distress

  • J.S. Rossi et al.

    Motivational readiness to control weightthe Transtheoretical Model of Behavior Change

  • S.R. Rossi et al.

    A processes of change model for weight control for participants in community-based weight loss programs

    Int J Addict.

    (1994)
  • C.C. Horwath et al.

    The challenge of behaviour change

    N Z Sci Monthly.

    (1998)
  • R.G. Laforge et al.

    Psychosocial factors influencing low fruit and vegetable consumption

    J Behav Med.

    (1994)
  • K. Glanz et al.

    Stages of change in adopting healthy dietsfat, fiber, and correlates of nutrient intake

    Health Educ.

    (1994)
  • Betts NM, Strong J. Measuring young adults' stage of change. Paper presented at: Society for Nutrition Education 31st...
  • S.R. Rossi et al.

    Cross validation of a decisional balance measure for dietary fat reduction [abstract]

    Ann Behav Med.

    (1994)
  • S.R. Rossi et al.

    Confirmation of a situational temptation measure for dietary fat reduction [abstract]

    Ann Behav Med.

    (1994)
  • S. Rossi et al.

    Continued investigation of a process of change measure for dietary fat reduction [abstract]

    Ann Behav Med.

    (1994)
  • J.O. Prochaska et al.

    In search of how people changeapplications to addictive behaviors

    Am Psychol.

    (1992)
  • G.R. Reed et al.

    What makes a good staging algorithmexamples from regular exercise

    Am J Health Promot.

    (1997)
  • S.J. Curry et al.

    An application of the stage model of behavior change to dietary fat reduction

    Health Educ Res.

    (1991)
  • Cited by (183)

    View all citing articles on Scopus
    View full text