Applying the transtheoretical model to eating behaviour change: challenges and opportunities

Abstract

This review provides a rigorous investigation of the question of whether the transtheoretical model (TTM) (or stages of change model) is applicable to eating behaviour change. The TTM is currently the most popular of a number of stage theories being used to examine health behaviour change. Stage theories specify an ordered set of`stages of readiness to change' into which people can be classi®ed and identify the factors that can facilitate movement from one stage to the next. If eating behaviour change follows a stage process, then nutritionists could identify the predominant stage or stages in a population and focus resources on those issues most likely to move people to the next stage (e.g. from no intention of changing, to thinking about changing). In addressing this question, the review draws on the de®ning characteristics of stage theories as clari®ed by Weinstein et al. (1998), provides an in-depth coverage of methodological considerations, and a detailed summary table of dietary studies applying the TTM. Speci®c recommendations are made for improving the accuracy of dietary stage classi®cations. Among the key conclusions are: (1) dietary studies using the TTM have been hampered by a focus on nutritional outcomes such as dietary fat reduction, rather than clearly understood food behaviours (e.g. ®ve servings of fruit and vegetables per day); (2) accurate stage classi®cation systems are possible for food-based goals, but major misclassi®cation problems occur with nutrient-based goals; (3) observation of an association between stage and dietary intake is not suf®cient to demonstrate the validity of the model for dietary behaviour; (4) there is a need for valid questionnaires to measure all aspects of the TTM, and more research on the whole model, particularly the`processes of change', rather than on single constructs such as`stage'; (5) cross-sectional studies generally support the predicted patterns of between-stage differences in decisional balance, self-ef®cacy, and processes of change; (6) studies which test the key hypothesis that different factors are important in distinguishing different stages are rare, as are prospective studies and stage-matched interventions. Only such studies can conclusively determine whether the TTM is applicable to eating behaviour. Since the ultimate test of the TTM will be the effectiveness of stage-matched dietary interventions, the review ends by exploring the requirements for such studies.

Validating stage of change measures for physical activity and dietary behaviors for overweight women

“…43,44 One study noted discrepancy between DF stage of change measure classification results when two methods of classifying stage of change, self-reported intake versus food-frequency questionnaire estimation, were compared. 45 To improve validity outcomes, Horwath 46 recommended DF stage measures inquire about clear dietary behaviors (for example, similar to 'five servings of FVs daily') rather than a general nutritional outcome (that is, intake no more than 30% calories from DF). The authors acknowledge that there is little evidence valid for the present study's DF stage of change measure and therefore do not recommend it for use or further validation studies.…”

Potentials and pitfalls for nutrition counselling in general practice

“…One of the reasons may be that the behavioural criteria that are set for the action and maintenance stages are related to balance, moderation, and graduation of intake for dietary change, as opposed to complete abstinence such as in smoking cessation in which the Stages of Change Model was originally developed (Prochaska et al, 1994). The poor understanding of the goal behaviour by the lay public (especially for specific nutrient goals) and common misconceptions in dietary fat intake (Brug et al, 1994;Glanz et al, 1997;Horwath, 1999) complicate the use of the model in practice. The customary approach for people in maintenance (reinforcing people) is inappropriate if people mistakenly think they are eating a low-fat diet.…”

Adaptação transcultural dos estágios de mudança de comportamento e processos de mudança para a amamentação exclusiva

“…Todavia, dada a aplicação global e o sucesso do emprego do Modelo Transteorético em vários comportamentos na área da saúde relatados na literatura 6,12,13 , torna-se evidente sua aplicabilidade no estudo da amamentação. Além disso, a singularidade e a praticidade da forma como são avaliados no modelo os construtos estágios e processos de mudança possibilitam sua incorporação na rotina da assistência à amamentação nos serviços públicos de saúde brasileiros.…”