• Journal of Korean Academy of Nursing
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• v.30 no.5
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• pp.1265-1278
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• 2000

This study was carried out to assess the perception of decisional balance of Korean subjects about 4 health behaviors and to identify the influencing factor of decisional balance for exercise acquisition, smoking cessation, mammography screening and Kegel's exercise acquisition. All are representative health behaviors nurses can intervene in Korea based on the Transtheoretical model. Convenient samples of 2,484 subjects (191; exercise, 169; smoking cessation, 1903; mammography screening and 221; Kegel's exercise) were selected from cities and counties over 9 provinces throughout Korea, and the data was collected from January 1, 1999 to February 29, 2000. The research instrument were the Decisional Balance Measure for Exercise (Marcus & Owen., 1992), Smoking Cessation (Velicer et al., 1985), Mammography Screening (Rakowski et al.,1992) and Kegel Exercise (Lim, 1999) and Stage of Change Measure for Exercise (Marcus et al, 1992), Smoking Cessation (DiClemente et al., 1991), Mammography Screening (Rakowski et al.,1992) and Kegel's Exercise (Lim, 1999). The data was analyzed by the SAS Program. The results are as follows; 1. According to the stage of change measure, 2,484 subjects were distributed in each stage of change for four health behaviors: 1,233 subjects (49.8%), 745 subjects (30.2%), 113 subjects (4.7%), 156 subjects (6.5%), and 216 (8.7%) belonged to the pre- contemplation stage, contemplation stage, preparation stage, action stage and maintenance stage. They were all series of stages of change in their efforts to do health behavior. 2. Factor analysis identified 3 factors (1 of Pros, 2 of Cons) for the exercise, 4 factors for smoking cessation (2 of Pros, 2 of Cons), 2 factors (1 of Pros, 1 of Cons) for the mammogram screening and 2 factors (1 of Pros, 1 of Cons) for Kegel's exercise of decisional balance. 3. The analysis of variance and multiple comparison analysis showed that for all 4 samples, the Cons of changing the problem behaviors outweighed the Pros for subjects who were in the pre- contemplation stage, The opposite was true for subjects in action and maintenance stage. 4. Through the discriminant analysis, it was found that one factor of Pros for exercise, one factor of Cons for smoking cessation, 1 factor of Cons for mammogram screening and one factor of Cons for Kegel's exercise were the more influencing factors, than others in discriminating the stages of change. Results are consistent with the applications of the Transtheoretical model, which have been used to understand how people change health behaviors. This results provide some evidence that subject's report of his/her health behavior corresponds to beliefs about usefulness of related health behaviors. The results of this study have implications for patients' health education and health intervention strategies. The findings of this study give useful information for nursing educators for 4 health behaviors, especially the factors relating to decision making in the different stages of change.

• Nutrition Research and Practice
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• v.11 no.3
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• pp.247-256
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• 2017

BACKGROUND/OBJECTIVES: Easy access to intervention and support for certain behaviors is important for obesity prevention and management. The available technology such as smartphone applications can be used for intervention regarding healthy food choices for obesity prevention and management in elementary-school students. The transtheoretical model (TTM) is comprised of stages and processes of change and can be adopted to tailored education for behavioral change. This study aims to develop TTM-based nutrition contents for mobile applications intended to change eating behaviors related to weight gain in young children. SUBJECTS/METHODS: A synthesized algorithm for tailored nutrition messages was developed according to the intake status of six food groups (vegetables, fruits, sugar-sweetened beverages, fast food and instant food, snacks, and late-night snacks), decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. The messages in this study were developed from December 2014 to April 2015. After the validity evaluation of the contents through expert consultation, tailored nutrition information messages and educational contents were developed based on the TTM. RESULTS: Based on the TTM, stages of subjects are determined by their current intake status, decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. Three versions of tailored nutrition messages at each TTM stage were developed so as to not send the same messages for three weeks at most, and visual materials such as figures and tables were developed to provide additional nutritional information. Finally, 3,276 tailored nutrition messages and 60 nutrition contents for applications were developed. CONCLUSIONS: Smartphone applications may be an innovative medium to deliver interventions for eating behavior changes directly to individuals with favorable cost-effectiveness. In addition, using the TTM for tailored nutrition education for healthy eating is an effective approach.

• Nutrition Research and Practice
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• v.11 no.4
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• pp.319-326
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• 2017

BACKGROUND/OBJECTIVE: Effective weight reduction remains a challenge throughout the world as the prevalence of obesity and its consequences are increasing. This study aimed to determine the effects of an individualized nutrition counseling program (IC) matched with a transtheoretical model (TTM) for overweight and obese subjects. SUBJECTS/METHODS: Fifty overweight and obese subjects aged 19-60 years with a body mass index ${\geq}23kg/m^2$ were enrolled in the weight reduction study. They were randomized into two groups: Intervention group received an IC matched with a TTM; control group received an educational handbook. Body weight (BW), body fat (BF), waist circumference (WC), waist to height ratio (WHtR), stages of change (SOC), processes of change (POC), food intake, and physical activity (PA) were assessed at baseline and at 4, 8, and 12 weeks after program initiation in both groups. All data were analyzed by intention-to-treat, using SPSS software for hypothesis testing. RESULTS: Forty-five female subjects were included in the 12-week trial at Ramkhamhaeng Hospital, Bangkok, Thailand. The results showed significant weight loss ($1.98{\pm}1.75kg$; 3% loss of initial weight) in the intervention group at 12 weeks, compared to a $0.17{\pm}1.67kg$ loss in the control group. There were significant differences between intervention and control groups in BF mass ($-1.68{\pm}1.78$, $-0.04{\pm}1.62kg$); percentage BF ($-1.54{\pm}2.11$, $0.08{\pm}2.05$); WC ($-5.35{\pm}3.84$, $0.13{\pm}3.23cm$); WHtR ($-0.0336{\pm}0.02$, $-0.0004{\pm}0.02$), and energy consumption ($-405.09{\pm}431.31$, $-74.92{\pm}499.54kcal/day$) in the intervention and control groups, respectively. Intragroup SOC was improved in both groups. The POC for the weight management action (WMA) process was significantly different with POC scores increasing by $16.00{\pm}11.73$ and $7.74{\pm}14.97$ in the intervention and the control groups, respectively. PA level did not change in either group. CONCLUSIONS: The IC matched with a TTM resulted in reductions in BW, BF, and WC, thus reducing likely health risks by decreasing energy intake and inducing positive behavior changes while enhancing the WMA process.

• Korean Journal of Social Welfare Studies
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• v.49 no.1
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• pp.5-28
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• 2018

Smoking is one of the important public health concerns because it is preventable causes regarding individuals' negative health consequences and increased social and economic cost. However, few studies have examined longitudinal patterns of stages of changes(SOC) in smoking behaviors among the general population. The purpose of the study is to explore the latent patterns of SOC over time among Korean adult smokers using the 2008-2016 Korea Welfare Panel Study. A repeated measure latent class analysis is employed in the present study. The finding of the present study are as follows: First, four latent groups were identified: (1) action/maintenance stage(33.6%), (2) contemplation/preparation to action/maintenance stage(14.8%), (3) continuously contemplation/preparation stage(29.6%), and (4) continuously pre-contemplation stage(22.1%). Second, the results of a multinomial logistic regression found that socio-demographic and clinical characteristics were associated with the identified longitudinal patterns of smoking behaviors. Compared to a continuously pre-contemplation stage, higher levels of depressive symptoms and drinking behavior were associated with increased odds of being in action/maintenance stage. The findings of the present study highlight that a tailored intervention is needed for individuals with continuously pre-contemplation stage and contemplation stage.

• Journal of Korean Academy of Nursing
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• v.35 no.8
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• pp.1443-1450
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• 2005

Purpose. The study was conducted to identify predictors of mammography screening for rural Korean women according to 'Stage of Change' from the Transtheoretical Model which, along with the Health Belief Model, formed the theoretical basis for this study. Methods. A cross-sectional descriptive design was utilized. Through convenience sampling 432 women were selected from 2 rural areas. Data were collected by survey. Health beliefs constructs were measured with Champion's HBM Scale-Korea version. Mammography participation was measured using the Stage of Mammography Adoption Scale developed. by Rakowski, et al.(1992). Results. The most frequent stage of mammography adoption was 'contemplation' ($40.5\%$). Predictors of stage of mammography adoption included 'mammogram recommended by health professional' (beta==0.59, t=16.12, p=.000), 'perceived benefits' (beta=0.09, t=2.21, p=.050), 'perceived susceptibility' (beta=0.09, t=1.98, p=.050), and 'perceived barriers' (beta=-0.07, t=-2.05, p=.041). 'Mammogram recommended by health professional' demonstrated the greatest association with having a mammogram. Conclusion. Health professionals play key roles in improving mammography participation and should recognize the importance of their role in cancer prevention and be more actively involved in education and counseling on prevention of breast cancer.

• Korean Journal of Adult Nursing
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• v.18 no.4
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• pp.573-581
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• 2006

Purpose: This study was to predict the stage of exercise behavior change in undergraduate students and to identify the factors affecting exercise behavior change by using the trans theoretical Model. Method: The subjects were 193 undergraduate students at K and D university in D city. Data were collected by questionnaire surveys using convenience sampling and analyzed by SPSS 12.0 program. Results: 77.7% of 193 nursing students do not exercise or they exercise irregularly. Exercise self-efficacy score and exercise benefits score were decreased with advancing exercise stage, on the other hand exercise barriers score and the process of exercise behavior change score were increased. In addition to this, the results revealed that stage of exercise behavior was significantly correlated with the process of exercise behavior change, exercise benefits, exercise barriers and exercise self-efficacy. Conclusion: These results suggested that the process of exercise behavior change, exercise decisional balance and exercise self-efficacy can be potential affecting factors for the stages of behavior change in university students. Therefore, these findings give useful information for educating nurse to construct nursing service programs focused on the stage of behavior change.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.13 no.3
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• pp.409-418
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• 2006

Purpose: This study was done to identify the process of change, decisional balance and self-efficacy corresponding to stage of exercise behavior based on the Transtheoretical model in patients with chronic arthritis. Method: The participants were 151 patients with chronic arthritis using an out-patient pain clinic and hospital in C city. The collected data were analyzed using ANOVA, Sheffe test and discriminant analysis with SPSS/WIN. Results: The patients were distributed as follows for each stage of exercise behavior 21.8% in the precontemplation stage, 26.5% in the contemplation stage, 25.2% in the preparation stage, 7.3% in the action stage, and 19.2% in the maintenance stage. Significant effects for stage of change were found for nine of the 10 processes of change and Pros, Cons, self-efficacy. Scores on these variables were found to increase across the stage of exercise behaviors from precontemplation to maintenance. Discriminant analysis revealed that self-efficacy and stimulus control, and reinforcement management were the major correlates of the stage of exercise behaviors. Conclusion: The findings of this study give useful information for exercise intervention, by using strategies of exercise for chronic arthritis patients in different stages of exercise behavior.

• The Journal of Korean Academic Society of Nursing Education
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• v.19 no.4
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• pp.640-647
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• 2013

Purpose: The purpose of this study was to identify the effectiveness of smoking cessation education using the transtheoretical model on the process of change, smoking temptation, decisional balance and stage change transition. Methods: A nonequivalent control group non-synchronized design was used for this study. The study population was 44 male college students in the experimental group and 66 students in the control group. Smoking cessation education was administered to the experimental group at one university. Descriptive analysis, t-test, and ANCOVA were used with the SPSS 19.0 program to analyze the data. Results: After providing a smoking cessation program, the experimental group showed significantly higher scores for self-efficacy for smoking cessation, process of change, and a lower score in decisional balance for pros of smoking and nicotine dependancy compared to the control group two weeks after the pre-test. However, no significant differences were found at four weeks after the pre-test. Conclusion: The findings indicate that this program could have a positive effect on process of change, decisional balance and stage transition for college student smokers.

• Women's Health Nursing
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• v.6 no.2
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• pp.191-202
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• 2000

This study was carried out to assess the perception of decisional balance of Korean women toward mammography screening. From Dec. 20, 1998 to Apr. 30, 1999, a samples of 1,903 subjects were selected from 7 metropolitan areas and 6 provinces of Korea. Data was collected using Rakowski et al's decisional balance scale to measure the decisional balance regarding a woman's adoption of mammography screening and to assess the woman's current stages of adoption of mammography. The classification of women according to the stage of adoption of mammography was 54.9 % in precontemplation, 31.9 % in contemplation, 7.8 % in action, and 5.5 % in maintenance. The mean difference of pros, cons, and the decisional balance by the stage of mammography adoption were statistically significant. There were significant mean differences between the stages of adoption according to a woman's experience with and intention for mammography and the pros score, the cons score, and the decisional balance score. The behavioral portion of stage of mammography adoption provides a further level of discrimination. Results provide the empirical evidence for the Transtheoretical model.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.17
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• pp.7287-7290
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• 2014

Background: Brief physician counselling has been shown to be effective in improving smokers' behaviour. If the counselling sessions can be given at the workplace, this would benefit a larger number of smokers. This study aimed to determine the effectiveness of a ten-minute physician counseling session at the workplace in improving smoking behaviour. Materials and Methods: This prospective randomised control trial was conducted on smokers in a factory. A total of 163 participants were recruited and randomised into control and intervention groups using a table of random numbers. The intervention group received a ten-minute brief physician counselling session to quit smoking. Stages of smoking behaviour were measured in both groups using a translated and validated questionnaire at baseline, one month and three months post intervention. Results: There was a significant improvement in smoking behaviour at one-month post intervention (p=0.024, intention to treat analysis; OR=2.525; CI=1.109-5.747). This was not significant at three-month post intervention (p=0.946, intention to treat analysis; OR=1.026; 95% CI=0.486-2.168). Conclusions: A session of brief physician counselling was effective in improving smokers' behaviour at workplace, but the effect was not sustained.