Use of TTM in Research and Practice
The study targeted physical activity in young adults via The Transtheoretical Model of behavior (TTM). According to the TTM, people can be in different stages of readiness to change one’s behavior (Brewer & Rimer 2008). The study consisted of two packages on active living, PAL 1 and PAL 2, which were conducted in November and January respectively.
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The students chosen for the study were divided into contemplators and contemplators. During the first stage (pre-contemplation), the measure of intervention (consciousness-raising) was in addressing students’ awareness of their lifestyle by providing them with materials via their post. During the second stage (contemplation), students went through social liberation, i.e., they understood that physical activity was supported by other students and in the university environment. During the third stage (preparation), students used self-re-evaluation to understand whether these activities would be beneficial for them.
The fourth stage (action) caused both self-liberation and counter-conditioning (students slowly became active and began with small steps). The fifth stage (maintenance) was supported by helping relationships. During this stage, students were actively engaged in the activity for six months or more and tried to maintain the pace; their objective was supported by friends who participated in the activity as well (Woods, Mutrie, & Scott 2002). During the last stage (final maintenance), reward management was used as a measure of intervention. It did not only include rewards from PAL 2 but also encouraged students to praise themselves for the effort.
The effectiveness of the intervention can be explained through its effective staging; Woods, Mutrie, and Scott (2002) point out that helping individuals progress through one stage increases the chances of activity adherence in the future. The self-instructional nature of the intervention could also facilitate the necessary cognitive change.
Use of PAPM in Research and Practice
The Precaution Adoption Process Model argues that people go through several stages before making a decision to modify their behavior (Brewer & Rimer 2008). The variables that influenced the decision on CRC were sex, education (college or higher), doctor’s recommendations, and self-efficacy.
To the individuals who were going through the first four stages (unaware, unengaged, undecided, and decided not to screen) the authors recommend providing information about screening recommendations and available tests to increase their awareness (Hester et al. 2015). To engage people at third, fourth, fifth, sixth, and seventh stage (undecided, decided not to screen, decided to be screened, action, and maintenance), barriers to CRC have to be addressed.
For example, these barriers can include inconvenience, fatalism, pain, or difficulties in self-efficacy (e.g., people with disabilities), as well as prior screening history. If people at these stages are reluctant to be screened, additional support and removal of barriers can potentially increase their willingness to participate in screening. It should be noted that those who were going through the sixth and the seventh stage (action and maintenance) did not necessarily need intervention; nevertheless, if they experienced any barriers in being screened, interventions that increased their self-efficacy or access to CRC would be desirable.
As can be seen, the PAPM addresses decision stages in a precise manner and includes individuals who are unaware or unwilling to take action in an activity. As Bahmani et al. (2016) point out, limited or inadequate awareness can lead to negative consequences and undermine the rising level of awareness of various types of cancers and their screening. Therefore, PAPM can be an effective tool in supporting information distribution about CRC.
Bahmani, A, Baghianimoghadam, MH, Enjezab, B, Mahmoodabad, SSM & Askarshahi, M 2016, ‘Factors affecting cervical cancer screening behaviors based on the precaution adoption process model: a qualitative study’, Global Journal of Health Science, vol. 8, no. 6, pp. 211-218.
Brewer, N & Rimer, B 2008, ‘Perspectives on health behavior theories that focus on individuals’, in K Glanz, BK Rimer & K Viswanath (eds), Health behavior and health education: theory, research, and practice, John Wiley & Sons, New York, NY, pp. 1-13.
Hester, CM, Born, W., Yeh, HW, Young, KL, James, AS, Daley, CM & Greiner, KA 2015, ‘Decisional stage distribution for colorectal cancer screening among diverse, low-income study participants’, Health Education Research, vol. 30, no. 3, pp. 400-411.
Woods, C, Mutrie, N & Scott, M 2002, ‘Physical activity intervention: a transtheoretical model-based intervention designed to help sedentary young adults become active’, Health Education Research, vol. 17, no. 4, pp. 451-460.