• Korean Journal of Health Education and Promotion
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• v.28 no.3
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• pp.67-82
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• 2011

Objectives: The purpose of this study was to identify the factors influencing the stages of exercise behavior change after adjusting for related covariates. Methods: Participants included 362 of fourth to sixth graders in 3 elementary schools in a metropolitan city in Korea. The data were collected using structured questionnaire included Korean Stages of Change Scale for Exercise. Results: Logistic regression results showed that the motivational factors associated with transition from precontemplation to contemplation were cognitive process of change, self-reevaluation, conscious raising; regarding that from contemplation to preparation, cons of the decisional balance; regarding those from preparation to action, behavioral process, counter-conditioning, stimulus control, which were very similar to the results of previous researches subjected other age groups. But, there was no motivational factors associated with from action to maintenance, and self-efficacy had no influence on forwarding stages of change. Conclusions: TTM would be applicable to explain the exercise behavior of some children in Korea, which suggested that it be useful in developing the programs to improve physical activities of Korean school children.

• Women's Health Nursing
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• v.16 no.4
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• pp.317-325
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• 2010

Purpose: This study was to examine the differences in health belief variables and HPV (Human Papillomavirus) knowledge in Pap smears according to the stages of change using Trans-theoretical Model (TTM) among married nurses. Methods: The research design was a cross sectional survey. Participants were 387 married nurses working in general hospital located metropolitan city. Measurement variables were perceived threatening, perceived severity, benefits of Pap, HPV knowledge and stages of the change in Pap smear. Results: Classified stages were pre-contemplation 3.9%, contemplation 17.8%, relapsing 29.5%, action 31.0%, and maintenance 17.8%. Accuracy rate of HPV knowledge were low ranging from 15% to 45%. Among the variables, perceived threatening (F=3.56, p=.007), perceived severity (F=9.73, p<.001) and HPV knowledge (F=7.52, p<.001) were significantly different by stages of change. Conclusion: Application of TTM to Pap smears was efficient to know the nurse's level of health behaviors, Health belief variables and HPV knowledge were main factors to identify the stages of change. The continuation of Pap smears and the education in relation to HPV knowledge should be encouraged for married nurses.

• Korean Journal of Health Education and Promotion
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• v.23 no.2
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• pp.77-89
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• 2006

Objectives: Recent studies have shown that tailoring to women's individual beliefs and stage of cancer screening adoption increase the probability that cancer screening will ensue. To identify variables associated with cancer screening behavior, many studies for cancer screening have used the Transtheoretical Model(TTM). This study was carried out to identity the cognitive and behavioral factors associated with breast cancer screening by stages of change among women, forties aged. Methods: Building on the TTM constructs, we collected the data to test the association with cognitive and behavioral factors for breast cancer screening by stage of change among women, forties aged (N=232), using the self-reported questionnaire. The stages of change were grouped according to screening participation and intention for breast cancer as precontemplation, contemplation, preparation, action, and maintenance. We found out the association between breast cancer screening and cognitive and behavioral factors, and testified the difference between stages of change by chi-square test, one-way ANOVA, and multiple comparison analysis(Duncan test). Results: Analyses of 232 women showed that participation on mammography was 68.1% within lifetime and 46.1% within last 2 years, and we found out the association with breast cancer screening participation, intention and cognitive-behavioral factors. The stages of change based on participation and intention were different from the decisional balance, the screening attitude, and the self-efficacy(p<0.01). The decisional balance was differ from stages of change because the difference on opinions about pros(positives) and cons(negative) were likely to significant by stages of change(p<0.05, p<0.01). Conclusion: To increase the screening rate for breast cancer, it should be developed the tailored message and recommend guideline. And the tailored message should be designed to increase the pros of breast cancer screening(mammography) and to decrease the cons, and considered the woman's stage of adoption.

• Journal of Nutrition and Health
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• v.34 no.2
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• pp.222-229
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• 2001

This study describes the application of the stages of change construct to fat intake by examining the associations of the stages of change with nutritional status and beliefs on health behavior. Data were obtained from apparently healthy 596 adults(326 females and 270 males) residing in large cities. Stages of change assessed by an algorithms based on 6 items were designed each subject into one of the 5 stages: precontemplation(PC), contemplation(CO), preparation(PR), action(AC) and maintenance(MA). Beliefs on health behavior were assessed by self efficacy as well as 4 belief scales from the Locus of Illness Control(LIC) developed using factor analysis such as internal disease cure and prevention and external disease cure and prevention. Energy and fat intakes were measured by a 39 item short form food frequency questionnaire. Regarding the 5 stages of change, MA stage comprised the largest group(37.9%), followed by Ac(30.7%), PC(11.4%), CO(10.4%) and PR(9.6%). Subjects who were females, older or healthier were more likely to belong to either AC or MA. Stage assignment of individuals was corroborated by their nutritional variables. Those in PC had the most energy and fat and those in MA ate the least for females. BMI was higher in PR than any other stages for both males and females. Those in PC were distinctive in that they were more externally oriented in terms of health control showing higher scores on external disease prevention(for males) and external disease cure(for females), and lower score on internal disease cure. On the other hand, those in MA received the highest scores on internal disease prevention and self efficacy, which suggested that they were more internally oriented. Canonical discriminant function analysis indicated that the 5 stages were importantly discriminated by BMI, self efficacy, internal disease prevention and external disease prevention for males and by fat intake, self efficacy and external disease cure variables for females. The results of our study confirm differences in stages of change in fat intake in terms of nutritional status and beliefs on heath behavior and indicate the need for taking these phases of change into account in nutrition advice. (Korean J Nutrition 34(2) : 222-229, 2001)

• Korean Journal of Health Education and Promotion
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• v.22 no.1
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• pp.103-115
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• 2005

The Purpose of this study was to identify the process of change, decisional balance and self-efficacy corresponding to the stages of change in exercise behavior based on the Transtheoretical Model(TTM) in obese adolescents. A random sample of 517 obese adolescents was recruited in Pusan. The data were collected from June 15 to 30, 2004. The research instruments were Stages of Change for Exercise Behavior, Process of Change, Decisional Balance, and Self-Efficacy. The data were analyzed by descriptive statistics and ANOVA using SPSS WIN 10.0 program. The results of this study were as follows 1. The subjects were distributed in each stage of exercise behavior: There were 255 subjects($49.3\%$) in the contemplation stage, 131 subjects($25.3\%$) in the preparation stage, 52 subjects($10.1\%$) in the maintenance stage, 41 subjects($7.9\%$) in the action stage, and 38 subjects($7.4\%$) in the precontemplation stage. 2. Analysis of variance showed that cognitive process (F=13.57, p=.000), behavioral process(F=17.23, p=.000), decisional balance pros(F=11.95, p=.000), and self efficacy(F=12.52, p=.000) were significantly associated with the stages of exercise behavior change, but decisional balance cons(F=2.87, p=.023) was not significantly associated with the stages of exercise behavior change. This study can provide useful information for developing effective exercise behavior program considering obese adolescents' stages of change according t'.t the TTM.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.2
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• pp.1009-1016
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• 2013

Background: The benefits of physical activity are well established and recognized to prevent adults from many chronic diseases and particularly some forms of cancers. Objectives: The present study was conducted to investigate the present status of physical activity among Saudi adults in Al-Ahsa, and to examine the association between the stages of change for physical activity and perceived barriers, and self efficacy. Methods: A cross-sectional study of 242 subjects (118 males and 124 females) attending health centers aged between 20-56 years, were personally interviewed for demographic data, anthropometric measurement, physical activity level, stages of change for physical activity, self efficacy and perceived barriers. Results: Forty eight percent of the females were overweight and 16.9% of the males were obese with no significant difference between the genders for BMI categories. More than half of the females were inactive and 39% of the males were physically active with a significant difference (P=0.007). Twenty percent of the males were in maintenance stage, while similar percentage of the females were in contemplation stage. However the majority of the subjects were in pre-contemplation stage with a significant difference across the stages. Males had a higher mean score of self efficacy and less external barriers of physical activity. The major barrier among the females was lack of time ($7.2{\pm}1.4$) and in the males, lack of motivation ($7.7{\pm}1.4$). The females had less internal ($21.2{\pm}3.8$) barriers comparable to the males ($23.08{\pm}4.7$). Both genders had a significant relationship between stages of changes of physical activity and perceived barriers (internal and external), but in the females no significant difference across the stages was observed for self efficacy unlike the males who had a significant difference for self efficacy and self efficacy categories. Conclusion: The present study provided useful data on stages of change for physical activity and some psychosocial factors (self efficacy and perceived barriers) that can help to tailor strategies aiming at increasing physical activity level according to self efficacy and to the barriers detected, to prevent many chronic diseases including certain types of cancer in Saudi Arabia.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.14 no.2
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• pp.230-238
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• 2007

Purpose: The Transtheoretical Model (TTM) is a theoretical construct explaining stages of health behavior change. The purpose of this study was to describe and analyze the stages of health behavior change and health related quality of life (HRQL), Method: A descriptive survey design was utilized, and, using a questionnaire, which included a series of 5 questions designed to assess stages of health behavior change and HRQL instrument, data were collected from 292 adults. Means, standard deviation, t-test, ANOVA, and SNK test were used to analyze the collected data. Results: Health risk behaviors were lack of stress management(44%), alcohol use (42.5%), poor nutrition (37%), smoking (36.3%), a lack of spirituality (28.8%), poor communication skills (21.9%), Lack of safety(21.6%), lack of fittness (20.1%), violent behavior(12.3%), and drug use(6.8%). There was a significant difference in HRQL according to stage of health behavior change (P=0.001). Conclusion: The results of the study identified the need for individualized nursing interventions that based on the stage of health behavior change. Nursing interventions that focus on the stage of health behavior change would be effective for health promotion for Koreans.

• Korean Journal of Health Education and Promotion
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• v.25 no.3
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• pp.59-75
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• 2008

Objectives: The purpose of this study was to identify the stages of change distributions for nine major health behaviors among poor children in underserved area, and to provide basic information for developing specific objectives and strategies for health education program. Methods: The health behavior data were obtained with a self-administered questionnaire and analysed for 3,081 poor children in 106 local children's centers nationwide. Stages of change classification were based on self-reported responses to five statements. The health behaviors included were balanced diet, safety behavior (helmet and protective device use while riding), regular exercise, smoking, alcohol use, drug use, sleep pattern, weight management and stress management. Results: Poor children were more likely in precontemplation and less frequently in action and maintenance stages for a safety behavior. 33.1% of respondents were precontemplators, 29.9% contemplators, and 6.5% in preparation stage. Only 4.3% and 9.6% were in action and maintenance stages, respectively. Gender differences were apparent. Boys were more likely to be precontemplators for nine health behaviors. Children from the lowest socioeconomic status and disrupted family were more likely to be in precontemplation for weight management and exercise behaviors. Children living with both parents were more likely to be in the action and maintenance stages for nine health behaviors. Stages of change for balanced diet and smoking were significantly related with those for other eight health behaviors. And the stage of exercise adoption was found to be significantly related with those for other seven health behaviors. Conclusion: Safety education must receive high priority in health education program for low income children. Balanced diet smoking cessation and regular exercise could be a possible gateway behavior toward healthier lifestyle practices.

• Journal of Korean Academy of Nursing
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• v.36 no.6
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• pp.1023-1032
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• 2006

Purpose: The purpose of this study was to identify nicotine dependence, smoking-related attitude, and subjective norms across the stages of change for smoking cessation among adult smokers in a rural area. Method: The subjects were 276 current smokers (male=243, female=33). There were 3 stages of change for smoking cessation: pre-contemplation, contemplation, and preparation stage. Data was collected by an interview or self-reporting from February 12th to March 5th 2004, and analyzed with frequency, percentage, $X^2-test$, Fisher's exact probability test, ANOVA, and Scheffe test using the SPSS-PC program. Result: According to the stages of change, 114(41.3%) current smokers were in pre-contemplation, 110(39.9%) in contemplation, and 52(18.8%) in the preparation stage. There was a higher percentage of males than females ($X^2-test$=8.99, p=.011) in the preparation stage. The mean score of the smoking-related attitude (F:7.43, p=.001) and subjective norm(F=27.41, p=.001) were both lowest in the pre-contemplation stage and increased positively during the stages of change for smoking cessation. Conclusion: Based on these findings, the authors recommend that community-based smoking cessation programs should be developed by considering the intention or motives of current smokers and should be initiated in the preparation stage and primarily for male groups.

• Korean Journal of Community Nutrition
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• v.17 no.1
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• pp.1-13
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• 2012

The purpose of this study was to examine beliefs, self-efficacy and eating behaviors by the stages of change in vegetable consumption among college students (n = 297). A survey was conducted to examine study variables, and subjects were categorized into three groups based on the stages of change: precontemplation/contemplation stage (PC/C), preparation stage (P), action/maintenance stage (A/M). Subjects had 3.7 servings of vegetables a day, and vegetable consumption was significantly different by stages of change (p < 0.001). The A/M group showed higher score on beliefs regarding vegetable consumption (p < 0.001) than the other groups, and perceived benefits of vegetable consumption (e.g. cancer prevention) more strongly (p < 0.05). The PC/C group felt more barriers than the A/M group, such as disliking cooking methods, texture of vegetables (p < 0.001), bad taste and bad experience of eating vegetables (p < 0.05). Self-efficacy score was 27.2, with decreasing self-efficacy from A/M to P, PC/C (p < 0.001). The A/M group showed more confidence in nine behaviors such as "eating vegetables during meals" and "replacing menu at home with more vegetable dishes" (p < 0.001) than the other groups. The A/M group had more desirable eating behaviors (e.g, having a variety of foods, eating regularly, consumption of food groups). This study suggests that target population for education and educational strategies be different based on the stages of change. For those in the PC/C stage, education might focus on reducing barriers and increasing self-efficacy. For those in the A/M stage, it is necessary to use strategies to maintain and reinforce behaviors for enough vegetable consumption.