Is the sequencing of change processes by stage consistent across health problems? A meta-analysis.

: Clinicians and researchers applying the transtheoretical model (J.O. Prochaska, C.C. DiClemente, & J.C. Norcross, 1992) to health promotion often assume that relationships of processes and stages observed in smoking cessation can be generalized to other problems. A reanalysis of 47 cross-sectional studies determined that use of change processes varies by stage, but the sequencing of processes is not consistent across health problems. In smoking cessation, cognitive processes were used in earlier stages than were behavioral processes. In exercise adoption and diet change, use of behavioral and cognitive processes increased together. Results for substance abuse and psychotherapy were less consistent. Substituting new behaviors, making a commitment, considering consequences, seeking information, controlling cues, and using rewards varied most by stage. Future longitudinal studies should assess these processes as potential mediators of lifestyle change.

[1]  J. Prochaska,et al.  A processes of change model for weight control for participants in community-based weight loss programs. , 1994, The International journal of the addictions.

[2]  T. Gorely,et al.  An Examination of the Transtheoretical Model and Exercise Behavior in Older Adults , 1995 .

[3]  C C DiClemente,et al.  Gender and smoking cessation: a factor structure comparison of processes of change. , 1996, Journal of consulting and clinical psychology.

[4]  W F Velicer,et al.  Increasing mammography among women aged 40-74 by use of a stage-matched, tailored intervention. , 1998, Preventive medicine.

[5]  J. Prochaska,et al.  Transtheoretical therapy: Toward a more integrative model of change. , 1982 .

[6]  C. Diclemente,et al.  Doing the right thing at the right time? The interaction of stages and processes of change in successful smoking cessation. , 1996, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[7]  W F Velicer,et al.  Applying the transtheoretical model to a representative sample of smokers. , 1995, Addictive behaviors.

[8]  R. Levy The transtheoretical model of change: An application to bulimia nervosa. , 1997 .

[9]  J. Prochaska,et al.  Processes of change in smoking cessation: a cross-validation study in cardiac patients. , 1992, Journal of substance abuse.

[10]  D. Abrams,et al.  The stages and processes of exercise adoption and maintenance in a worksite sample. , 1992, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[11]  D. Gill Journal of Sport and Exercise Psychology , 1987 .

[12]  Terry E. Duncan,et al.  Social support and efficacy cognitions in exercise adherence: A latent growth curve analysis , 1993, Journal of Behavioral Medicine.

[13]  W. Miller,et al.  Treating Addictive Behaviors , 1986, Applied Clinical Psychology.

[14]  J. Cousins,et al.  Application of the transtheoretical model of behavior change for obesity in Mexican American women. , 1998, Addictive behaviors.

[15]  K. Ahijevych,et al.  Processes of change across five stages of smoking cessation. , 1992, Addictive behaviors.

[16]  C. Diclemente,et al.  Alcoholism Treatment Mismatching from a Process of Change Perspective , 1992 .

[17]  V. Strecher,et al.  One size does not fit all: The case for tailoring print materials , 1999, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[18]  R. Terry,et al.  Stages and processes of change among polydrug users in methadone maintenance treatment. , 1995, Drug and alcohol dependence.

[19]  M. Gabe Mental health: a report of the Surgeon General. , 2000, Home care provider.

[20]  C. Rosen,et al.  Integrating stage and continuum models to explain processing of exercise messages and exercise initiation among sedentary college students. , 2000, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[21]  M. Breteler,et al.  The effectiveness of smoking cessation programs: Determinants and outcomes , 1996 .

[22]  Windy Dryden,et al.  Handbook of Psychotherapy and Behavior Change , 1987, Journal of Cognitive Psychotherapy.

[23]  J. Prochaska,et al.  Stages and processes of self-change of smoking: toward an integrative model of change. , 1983, Journal of consulting and clinical psychology.

[24]  W Hall,et al.  Patient matching in treatment for alcohol dependence: is the null hypothesis still alive and well? , 1999, Addiction.

[25]  Jacob Cohen Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[26]  W F Velicer,et al.  The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. , 1991, Journal of consulting and clinical psychology.

[27]  J. Prochaska,et al.  Toward a comprehensive, transtheoretical model of change: Stages of change and addictive behaviors. , 1998 .

[28]  K. Courneya,et al.  Transtheoretical Model: examining adolescent exercise behavior. , 1998, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[29]  R. Dishman Advances in exercise adherence. , 1994 .

[30]  L. Degenhardt,et al.  The 12-month prevalence of substance use and ICD-10 substance use disorders in Australian adults: findings from the National Survey of Mental Health and Well-Being. , 1999, Addiction.

[31]  R. Wing,et al.  Benefits of recruiting participants with friends and increasing social support for weight loss and maintenance. , 1999, Journal of consulting and clinical psychology.

[32]  W F Velicer,et al.  Measuring processes of change: applications to the cessation of smoking. , 1988, Journal of consulting and clinical psychology.

[33]  K. Emmons,et al.  Do processes of change predict smoking stage movements? A prospective analysis of the transtheoretical model. , 1999, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[34]  Alexander J. Rothman,et al.  Stage theories of health behavior: conceptual and methodological issues. , 1998, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[35]  D. Orlinsky,et al.  Process and outcome in psychotherapy: Noch einmal. , 1994 .

[36]  U. Pallonen,et al.  Transtheoretical measures for adolescent and adult smokers: similarities and differences. , 1998, Preventive medicine.

[37]  J. Treasure,et al.  To change or not to change--'how' is the question? , 1996, The British journal of medical psychology.

[38]  Robin Davidson,et al.  The transtheoretical model: A critical overview. , 1998 .

[39]  G. Wilson,et al.  Behavioral treatment of obesity: thirty years and counting☆ , 1994 .

[40]  Colleen A Redding The transtheoretical model applied to safer sex behavior among university students: A cross-sectional investigation , 1993 .

[41]  A. Bandura Self-Efficacy: The Exercise of Control , 1997, Journal of Cognitive Psychotherapy.

[42]  L. Larson,et al.  A Partial Test of the Transtheoretical Model in Therapy with Adult Survivors of Childhood Sexual Abuse. , 1997 .

[43]  J. Prochaska,et al.  In Search of How People Change: Applications to Addictive Behaviors , 1992, The American psychologist.

[44]  C. Murphy,et al.  Stages and processes of change in Batterers' treatment , 1997 .

[45]  D. Bowen,et al.  Preliminary evaluation of the processes of changing to a low-fat diet , 1994 .