• 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.

• Journal of Community Nutrition
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• v.4 no.1
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• pp.51-58
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• 2002

Eating behavior change as a result of nutrition education interventions as secondary prevention strategies can contribute to an increase in life expectancy and better health for older adults in the United States (U.S.). Many of the chronic conditions prevalent in older adults are modifiable by dietary changes, including heart disease, diabetes mellitus, hypertension, obesity and osteoporosis. Important demographic observations in the U.S. including the projected large increase in number of older adults by 2030 have implications for nutrition education focus and services. A comprehensive review of nutrition education interventions for older adults in the U.S. published in 1995 identified elements from adult education theories that contribute to the effectiveness of nutrition education. These elements have been the focus of more recent studies with older adults providing additional evidence for relationships between concepts from commonly used behavior change theories and dietary patterns or change. In the U.S, an important program contributing to nutritional adequacy of the diet for older adults is the Elderly Nutrition Program which provides resources for congregate dining and includes a mandatory nutrition education component. Nutrition education is also provided through clinic based programs, and print and broadcast media. Application of the Transtheoretical Model has shown that the level of interest or motivation to comply with dietary guidance may be greater for some older adults due to an increasing burden of chronic disease and poorer quality of life, while others may not feel a need to change lifestyle habits.

• Korean Journal of Adult Nursing
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• v.16 no.1
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• pp.72-81
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• 2004

Purpose: The purpose of this study was to examine factors related to different stages of mammography screening based on the transtheoretical model (TTM) and health belief model (HBM). Method: 143 women were recruited from community centers in W city. The mean age was 44.08 (SD=7.78) and 74 (51.7%) had experienced education on preventative behavior related to breast cancer. The Decisional Balance Scale (Pros and Cons of mammography) and Stages of Adoption of Mammography Scale by Rakowski et al. (1992) and the revised Health Belief Model Scale (Perceived Seriousness, Perceived Susceptibility and Health Motivation) by Champion (1993) were used. Result: According to the stage of adoption of mammography, 17.4% of the women were In pre-contemplation, 45.5% in contemplation, 24.5% in action, and 12.6% in maintenance. The mean differences for pros, and the decisional balances between the stages of mammography adoption were significant (F=8.84, p=.000; F=7.20, p=.000). Education related to prevention of breast cancer was the most important variable. Prevention education, history of breast disease and pros of mammography explained the stages of mammography adoption ($R^{2}=26%$). Conclusion: Findings support TTM as a useful tool for improving mammography adherence. Behavioral interventions that target decisional balance and health belief can effectively promote adherence to mammography.

• The Journal of Korean Society for School & Community Health Education
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• v.12 no.3
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• pp.1-15
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• 2011

Objectives: We describe the development of a smoking and drinking prevention program for adolescents, using intervention mapping. Methods: The study sample consisted of 1,000 high school second-grade students from 6 high schools in Seoul. The PRECEDE model was applied for the needs assessment. We carried out a social diagnosis by assessing the factors such as the quality of life, happiness level, and satisfaction with school life; an epidemiological diagnosis on the perceived health status, stress levels, and priority of health issues; a behavioral diagnosis on the smoking and drinking rate and the intention to smoke and drink; and an educational diagnosis on knowledge, beliefs, attitudes, self-efficacy, outcome expectations, social norms and life skills. Results: The development process included a needs assessment, identifying factors that influence smoking and drinking among adolescents. Intention, knowledge, perceived norms, perceived benefit, perceived cost, perceived susceptibility, self-efficacy, and life skills were identified as determinants. Three performance objectives were formulated to describe what an individual needs to do in order to avoid smoking and drinking. Subsequently, we constructed an intervention matrix by crossing the performance objectives with the selected determinants. Each cell describes the learning objectives of the smoking and drinking prevention program. The program used methods from the transtheoretical model, such as consciousness raising, outcome expectations, self-reevaluation, self-liberation, counterconditioning, environmental reevaluation, and stimulus control. The program deals with the effects of smoking and drinking, self-improvement, decision making, understanding advertisements, communication skills, social relationships, and assertiveness. Conclusions: By using the process of intervention mapping, the program developer was able to ensure a systematical incorporation of empirical and new data and theories to guide the intervention design. Programs targeting other health-related behavior and other methods or strategies can also be developed using this intervention mapping process.

• Korean Journal of Health Education and Promotion
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• v.19 no.4
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• pp.61-76
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• 2002

The purpose of this study is to identify differences in processes of change, decision making, and self-efficacy by exercise behavioral stages and determine variables significantly affecting the older people's participation in exercises. The subjects of this study included 299 people aged 65 or over who were residents of G and S districts in Busan Metropolitan City. They were selected through purposive quota sampling at colleges and centers for old people and homes in order that they could be evenly distributed over stages of pre-contemplation, contemplation, preparation, action and maintenance. Data were analyzed using descriptive, ANOVA, Logistic Regression. Variables that discriminate between participants and non-participants in exercise include self-reevaluation, reinforcing management, cons and self-efficacy. Thus if variables that discriminate between participant and non-participation in exercise such as self-reevaluation, reinforcing management, cons and self-efficacy are fully considered in designing nursing interventions for inducing old people to become exercise participants, it would provide guidelines for nursing intervention programs as appropriate for the people's exercise stages. The purpose of this study is to identify differences in processes of change, decision making, and self-efficacy by exercise behavioral stages and determine variables significantly affecting the older people's participation in exercises. The subjects of this study included 299 people aged 65 or over who were residents of G and S districts in Busan Metropolitan City. They were selected through purposive quota sampling at colleges and centers for old people and homes in order that they could be evenly distributed over stages of pre-contemplation, contemplation, preparation, action and maintenance. Data were analyzed using descriptive, ANOVA, Logistic Regression. Variables that discriminate between participants and non-participants in exercise include self-reevaluation, reinforcing management, cons and self-efficacy. Thus if variables that discriminate between participation and non-participation in exercise such as self-reevaluation, reinforcing management, cons and self-efficacy are fully considered in designing nursing interventions for inducing old people to become exercise participants, it would provide guidelines for nursing intervention programs as appropriate for the people's exercise stages.

• Korean Journal of Adult Nursing
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• v.18 no.1
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• pp.146-156
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• 2006

Purpose: 1) to construct cohorts according to risk scores calculated with the Gail Breast Cancer Risk Assessment Tool (Gail et al., 1989) (Gail) and the Breast Cancer Risk Appraisal (Lee et al,. 2003) (Lee) 2) to identify the distribution of risk factors and preventive behavior stages between the cohorts 3) to identify abnormal breast conditions in risk cohort. Method: Using convenience sampling, 775 rural women were selected. Risk appraisal was scored using Gail and Lee. Preventive behavior stages for BSE (Breast self examination) and mammography were measured using 4 stages of the Transtheoretical Model (Prochaska & DiClemente, 1983). Results: 1) The risk cohort according to Gail was 12.3% (n=95), and Lee, 3.1% (n=24). 2) There were significant differences in the distribution of risk factors (age, family history, age at 1st live birth, age at menarche, number of breast biopsy, history of breast disease, and breast-feeding) between cohorts. 3) There was a significant difference in the distribution of the stage of BSE according to Lee. 4) Six women in the risk group detected masses or nodules and physician consultation and ultrasonography were recommended. Conclusion: On the basis of the constructed cohorts, further longitudinal studies of cohorts are recommended with interventions according to characteristics of cohorts.

• Korean Journal of Adult Nursing
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• v.14 no.1
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• pp.83-92
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• 2002

Purpose: This study was performed to identify the process of change, decisional balance and self-efficacy corresponding to the stage of exercise behavior using Transtheoretical Model in patients with type 2 diabetes mellitus. Method: The study method was a survey in 100 type 2 DM patients at out-patients clinic of Y medical center from March 19, 2000 to October 30, 2000. Result: The results were as follows: The subjects were divided into five stages of exercise behavior ; 15.0% in pre-contemplation stage, 33.0% in contemplation stage, 17.0% in preparation stage, 16.0% in action stage and 19.0% in maintenance stage. The subjects in pre-contemplation stage used all processes of change in the least. "Dramatic relief(DR)", "Environmental reevaluation(ER)" and "Self reevaluation(SR)" were identified as main processes of change in contemplation stage. "Consciousness raising(CR)", "DR" were used higher than average in preparation stage. Helping relationships(HR)", "CR", "ER", "SR", "Social liberation(SL)", "Counter conditioning (CC)", "Reinforcement management(RM)", "Self iberation(SEL)" and "Stimulus control(SC)" were used higher than average in action stage. The subjects in maintenance stage used all process of change the highest except "DR"and "HR". "Cons" score of decisional balance was the highest in pre-contemplation stage, "Pros" score was the highest in action stage and "Self-efficacy" score was the highest in maintenance stage. Conclusion: This study can provide the basis of staged matching exercise program using TTM for more effective and useful intervention.

• 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.

• Korean Journal of Health Education and Promotion
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• v.23 no.2
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• pp.11-27
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• 2006

Objectives: This study was conducted to evaluate the effects of a tailored program based on the Transtheoretical Model to smoking cessation in high school girls. Methods: A quasi-experimental research design was used in this study. The participants were 35 industrial high school girls who have been smoking. The girls were allocated to an experimental group(18) and a control group(17) by randomization. For intervention, the experimental group received the group smoking cessation program and individual program which tailored according to the stage of change. A common group smoking cessation program was given to the control group. Data were collected before the program, immediately after and 4 weeks after the program was completed and were analyzed with repeated measure ANOVA. Result: In the experimental group, the daily smoking amount, nicotine dependency and decisional balance(Pros) score were significantly decreased and the self-efficacy score were significantly increased at one month after the intervention in comparison with before and immediately after it. The decisional balance(Cons) and processes of change score of the experimental group were significantly increased at immediately after the intervention and one month after it in comparison with before it, and at one month after it in comparison with immediately after it. A significant difference in the daily smoking amount, urine cotinine, nicotine dependency, decisional balance(Pros, Cons) and processes of change score between the both groups was found after one month of intervention. Conclusions: The tailored smoking cessation program was more effective, compared to the common smoking cessation program on smoking behavior, self-efficacy, decisional balance, processes of change. This program can be used for favorable changes in high school girl's smoking behavior.

• Korean Journal of Health Education and Promotion
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• v.25 no.3
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• pp.77-94
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• 2008

Objectives: The purpose of this study was to develop the children obesity prevention program and to analyze how this program has an effect on students' degree of knowledge, attitude for obesity prevention. Methods: The study design was Compromise Experience Group Pre-Post Design. 238 students in the 4th and 5th grade of 4 elementary schools in Seoul were nonrandomly assigned to the study group(n=115) or the control group(n=113). The Program was applied for 3 times and surveys were conducted 2 times as pre-test and post-test. Results: 1. The obesity prevention CD-ROM was developed by analyzing of learners and educational facilities, selecting the study object and contents and producing educational methods and materials. The study contents were included definition, types, factors and side-effects of obesity, and It was contained dietary habit, exercise and life style for obesity prevention and healthy life. 2. Demographic characteristics were not significantly different between study group and control group. Among the subjects investigated, 27.8% of the study group and 38.1% of the control group stated that they had experienced in the obesity prevention program in past. 3. The obesity knowledge and attitude score after this obesity prevention program were improved significantly than before the program(P<0.001). Conclusion: The CD-ROM developed in this study for the children obesity prevention program was proven to be effective in improving obesity knowledge, attitude for the obesity prevention.