• 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.

• Journal of Korean Academy of Nursing
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• v.48 no.6
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• pp.656-668
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• 2018

Purpose: The purpose of this study was to develop and examine the effects of combined exercise program for older adults with sarcopenia based on transtheoretical model (TTM). Methods: A non-equivalent control group with a pretest-posttest design was used. The subjects consisted of 43 older adults with sarcopenia in precontemplation stage, contemplation stage and preparation stage of TTM (experimental group: 22, control group: 21). The developed program consisted of 36 sessions for 12 weeks including combined exercise (60 minutes) and TTM based strategies for enhancing exercise behavior (10 minutes) per session. Data were collected before, immediately after the program between July 31 to October 27, 2017. The data were analyzed using independent t-test, Mann-Whitney U test with SPSS/WIN 18.0. Results: Compared with their counterparts in the control groups, older adults with sarcopenia in the experimental group showed a significantly greater improvement in process of exercise behavior change, pros and cons of decisional balance for exercise behavior, exercise self-efficacy, parameters of muscle, and the level of physical performance. Conclusion: The study findings indicate that this combined exercise program for older adults with sarcopenia based on TTM model was effective and can be recommended as a nursing intervention for older adults with sarcopenia.

• Korean Parent-Child Health Journal
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• v.11 no.1
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• pp.61-72
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• 2008

This study is a descriptive research attempted to examine the exercise practice of junior high school students and figure out their changing process, decision-making balance, and self-efficacy according to the exercise practice so that they can be utilized as fundamental data for developing exercise intervention programs for junior high school students. The study subjects were students from five junior high schools in B City. Total 600 questionnaires were distributed, and 554 responded ones were analyzed. The collected data were analyzed using SPSS/Win 10.0. According to the results of analyzing the subjects with the exercise changing stage tool, exercise non-practice group including the precontemplation stage, contemplation stage, and preparation stage occupies 57.6% while the exercise practice group including the action stage and maintenance stage consists of 42.4%. And according to the results of discriminating analysis setting total 10 factors of transtheoretical model variables as predictive factors to predict each group based on whether they practice exercise or not, it was found out that the subordinate factors of the changing process, consciousness-raising (F=33.98, p=.000), self-cognitive decision (F=21.55, p=.000), contrary condition provision (F=84.67, p=.000), helping relationship (F=28.52, p=.000), reinforced thinking (F=14.15, p=.000), and stimulus control (F=54.64, p=.000), and the subordinate factors of the decision-making balance, beneficial factors (F=15.65, p= .000) and hindering factors (F=8.58, p=.004), and self-efficacy (F=78.60. p=.000) were significant predictive factors and discriminating variables. Based on the research findings above, it will be necessary to develop exercise intervention programs sufficiently reflecting the changing process, decision-making balance, and self-efficacy suitably for the subjects and make strategies to encourage their active participation and exercise maintenance, through verifying transtheoretical model variables according to whether the junior high school students practice exercise or not.

• 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 Adult Nursing
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• v.25 no.2
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• pp.136-147
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• 2013

Purpose: This study developed a program to facilitate evidence-based practice (EBP) in one nursing organization, and identifies the effects of the program on the nurses' EBP facilitators. Methods: The program was based on the Transtheoretical Model of stages of organizational change, a literature review, the cases of hospitals overseas, and a prior study. To identify the effects of the program, a one-group pretest-posttest study was conducted with 45 nurses who participated in the EBP implementation. Results: The program consisted of EBP educational sessions, consultations with academic nursing faculty and clinical EBP mentors, and support from the administration and relevant departments. After the EBP program, there was a statistically significant difference in belief in the value of EBP between the pretest and the posttest (t=2.31, p=.026). However, no significant differences were found between the pretest and the posttest for organizational support to develop EBP (t=0.62, p=.537), skills in locating and evaluating research reports (s=-1.00, p=.987), knowledge of research language and skills (s=-1.00, p=.986), and time to devote to EBP (s=-23.00, p=.711). Conclusion: The findings provide important data that can be used to develop and implement strategies for enhancing EBP in clinical settings in Korea.

• Korean Journal of Health Education and Promotion
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• v.22 no.2
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• pp.97-110
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• 2005

Objectives: Recent studies have shown that tailored messages for cancer screening to the beliefs and stage of cancer screening behavior of individual women increases the take-up probability. Many studies on cancer screening have used the Transtheoretical Model (TTM) to identify variables associated with cancer screening behavior. This study was carried out to identify the cognitive-behavioral factors associated with stomach cancer screening among women aged 40 years and over, and to develop and evaluate a tailored educational program for stomach cancer screening by stages of change. Methods: Building on the TTM constructs, we conducted a quasi-experimental study(N=283) to test the effectiveness of a tailored educational program for endoscopic stomach cancer screening. We carried out pre and post tests in the experimental group(N=162) and the control group(N=121), and the experimental group was subdivided into an on-line group(N=81) and an off-line group(N=81) by educational methodology using e-mail and the postal service. We used the chi-square test, trend test, and paired t-test to test the effectiveness of the program for stomach cancer using a tailored stage-matched messages. Results: To examine the effectiveness of the program for stomach cancer screening by the tailored stage-matched messages, the stage-matched materials were offered to the experimental group(N=162) four times for 4 weeks. The stage-matched materials consisted of the four types for stomach cancer. The tailored message was effective in changing the cognitive-behavioral factors, such as experience process, behavior process, con opinion for stomach cancer, self-efficacy, and the behavioral stages for stomach cancer screening. The stomach cancer screening adherence was higher for the stage-matched materials using postal mail than for those using e-mail. Conclusion: To improve the stomach cancer screening rate, the use of tailored messages for stomach cancer screening will be generated using an expert system. Therefore the implementation of tailored educational program will be supported a partnership between public and private health organizations and increasing awareness of the necessity of community-based interventions.

• 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.

• 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.

• 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.

• 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.